Journal of the Egyptian Society of Nephrology最新文献

{"title":"Assessment of postdialysis recovery time and associated hemodynamic changes by cardiometry in hemodiafiltration compared to conventional hemodialysis in patients on regular renal replacement therapy","authors":"SaidSayed Ahmed Khamis, AhmedMohamed Zahran, MagdyMohamed Said Elsharkawy, AhmedElsayed Ahmed Soliman, MohammadMahmoud Torayah","doi":"10.4103/jesnt.jesnt_9_23","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_9_23","url":null,"abstract":"Background Dialysis recovery time (DRT) has been shown to be a reliable marker of health-related quality of life (HRQOL) and increased mortality. More than 65% of prevalent HD patients report a DRT ≥2 h. The aim of this work was to study the relation of postdialysis fatigue to; demographic, social, clinical, laboratory characteristics and hemodynamic changes assessed by cardiometry of ESRD patients on regular renal replacement therapy using different dialysis modalities (HD and HDF). Also to compare between HD and HDF regarding clinical, laboratory characteristics and hemodynamic changes assessed by cardiometry. Patients and methods This cross-sectional study was carried out at Menoufia University Hospitals and Ain Shams University Hospitals included 73 ESRD patients, 50 patients on conventional HD from Menoufia University Hospitals and 23 patients on HDF from Ain Shams University Hospitals. Patients were classified according to the occurrence of PDF (TIRD ≥2 h) into two groups: - Group (I): Patients without postdialysis fatigue & Group (II): Patients with postdialysis fatigue. And also were classified hemodialysis modality into two groups: - Group (A): Patients on regular conventional HD & Group (B): Patients on regular HDF. We compared groups with respect to influential factors (socio-demographics, clinical and laboratory factors). Results The proportion of intradialytic hypotension episodes & ultrafiltration rate (UFR) was significantly higher in group II (P value = 0.034, 0.000). Group II patients had significantly lower hemoglobin level (Hb), dialysis adequacy (Kt/V), calcium(Ca) & vitamin D level (P value = 0.007, 0.001, 0.03 & 0.004 respectively) and significantly higher C‑reactive protein (CRP), Interleukin-6 (IL-6), Delta change of fluid thoracic content (Δ FTC) and Delta change of cardiac output (Δ CO) (P value = 0.01, 0.004, 0.04 & 0.008, respectively). There were significant positive correlations between PDF and UFR & Δ CO and negative correlation with Kt/V &Vitamin D. In multivariate analysis, UFR, Kt/V& Δ CO were independent predictors of PDF. There were statistical differences regarding (age, gender, occupation& original kidney disease) among group B (P value of <0.05) with decreased incidence of hypotension episodes & PDF. Group B had significantly higher Hb, Kt/V, Ca, vitamin D& iron (P value = 0.04, 0.001, 0.001, 0.02 & 0.02, respectively) and significantly lower Intact Parathormone (PTH), IL-6, Δ FTC & Δ CO (P value=0.02, 0.01, 0.006 & 0.01, respectively). Conclusion Ultrafiltration, dialysis adequacy and Delta change in cardiac output by cardiometry could be considered as independent predictors for postdialysis fatigue.","PeriodicalId":472816,"journal":{"name":"Journal of the Egyptian Society of Nephrology","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135798409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual function and reproduction in kidney transplantation","authors":"Ahmed Halawa, Amit Sharma, Dawlat Belal, Ajay Sharma","doi":"10.4103/jesnt.jesnt_26_22","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_26_22","url":null,"abstract":"Chronic kidney disease is characterized by sexual dysfunction and reduced fertility owing to the abnormal hypothalamic–pituitary–gonadal axis. Owing to the rapid restoration of fertility after transplant, prospective transplant recipients should be counseled regarding posttransplant contraception. Although intrauterine devices and hormonal contraceptives are the most commonly used forms of temporary contraception, the mode of contraception should be individualized. The effects of pregnancy on renal allograft and that of immunosuppression on the mother as well as on the fetus should be discussed with every prospective recipient of child-bearing age during pretransplant workup. Management of pregnancy in a transplant recipient involves a multidisciplinary approach involving nephrologists, transplant surgeons, and obstetricians. Guidelines recommend withholding pregnancy for at least 1 year after transplant. The prerequisites to planning conception in a female allograft recipient include steady allograft function, blood pressure under adequate control, and proteinuria of less than 1 g/day for 1 year. The immunosuppression should be suitably modified before conception to ensure that the patient is not taking any fetotoxic medications. This includes replacing mycophenolate mofetil with azathioprine. Close monitoring of calcineurin inhibitor drug levels is required during pregnancy. The mode of delivery could be either normal vaginal delivery or Cesarean section, depending on the decision made by the obstetrician. The benefits and risks associated with breastfeeding the baby should be discussed.","PeriodicalId":472816,"journal":{"name":"Journal of the Egyptian Society of Nephrology","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135798719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of progression to end-stage renal disease among patients with polycystic kidney disease type 1 in Alexandria Governorate Egypt","authors":"Noha El kholy, HebaS Elshair","doi":"10.4103/jesnt.jesnt_12_23","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_12_23","url":null,"abstract":"Background Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic cause of end-stage kidney disease (ESRD). Owing to the delay between onset of diagnosing the disease and renal outcome, the study of renal progression raises unique challenges in these patients. The aim of this study is to identify predictors of progression to ESRD among patients with a PCR-confirmed ADPKD-1. Material and methods The study population comprised patients with a PCR-confirmed ADPKD-1 between May 2019 and August 2022. Patients were distributed into two groups: Group I: 35 ADPKD-1 patients not receiving renal replacement therapy ( RRT) and Group II: 65 ADPKD-1 patients receiving RRT. Socio-demographic characteristics, smoking ,age at diagnosis , onset of hypertension, initiation of RRT, recurrent hematuria, and urinary tract infection were reported. Serum uric acid , and ultrasonography were done. Results No significant difference between the two groups regarding sex, family history of ADPKD-1, and time to develop hypertension. On the other hand, significantly higher percentage of group (II) patients were smokers compared with group (I). Recurrent hematuria and UTI were more prevalent among group (II) compared to group (I), the mean age at diagnosis of hypertension was significantly lower in group (II), the mean serum uric acid level was significantly higher in group (II). Moreover, significantly higher percentage of group (II) patients had two or more liver cysts. Conclusion Progression of ADPKD can be affected by several factors, including hypertension, hyperuricemia, hematuria, and UTI. Modification these factors may decrease the rate of the deterioration of renal function.","PeriodicalId":472816,"journal":{"name":"Journal of the Egyptian Society of Nephrology","volume":"283 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135798701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-saving induction immunosuppressive protocol in mild-to-moderate immunological risk renal transplantation","authors":"Mathew Eby, George Jacob","doi":"10.4103/jesnt.jesnt_1_23","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_1_23","url":null,"abstract":"Background Conventional induction immunosuppression is cost intensive in developing countries. We evaluated the role of low-dose rituximab (100 mg) with or without low-dose antithymocyte globulin (ATG) as an induction agent in moderate and mild immunologic risk renal transplantation, respectively. Patients and methods Of the 34 patients who underwent renal transplantation, 17 with mild immunological risk received induction with 100 mg of rituximab, and 17 with moderately increased immunological risk received an additional 1 mg/kg of ATG (group A). They were compared with 34 immunological risk-matched historic controls (group B), who did not receive any induction in mild immunological risk and 1 mg/kg of ATG alone with moderately increased immunological risk with regard to the incidence and type of biopsy-proven acute rejections, estimated glomerular filtration rate (eGFR), and infection rates at the end of 1 year after transplantation. Results Two (5.9%) patients in group A had biopsy-proven acute rejection during the first year compared with six (17.6%) in group B (P=0.047). None had antibody-mediated rejection in group A compared with two (5.9%) in group B (P=0.103). At 1 year, eGFR between group A and group B was 72.42 ± 15.02 and 67.97 ± 14.48 ml/min, respectively (P=0.25). Major infection episodes were noted in 18 (52.9%) and 20 (58.8%) in group A and group B, respectively (P=0.62). Conclusions Low-dose rituximab with or without low-dose ATG reduced overall biopsy-proven acute rejection in mild and moderate kidney transplant patients with comparable eGFR, and infection episodes at the end of 1 year and can be considered a cost-effective induction immunosuppressive protocol.","PeriodicalId":472816,"journal":{"name":"Journal of the Egyptian Society of Nephrology","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135798721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of induction of autophagy by rapamycin with or without metformin on the clinical and pathological aspects of diabetic nephropathy in rats","authors":"Emad Samaan, Samar Ahmed, Hussein Sheashaa, DinaAbdallah Ibrahim, Nagy Sayed-Ahmed","doi":"10.4103/jesnt.jesnt_15_23","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_15_23","url":null,"abstract":"Background The induction of autophagy by synergistic activation of mTORC1 and reduction of AMPK may be a novel therapeutic option for suppressing diabetic nephropathy (DN) progression. Materials and Methods Forty-eight adult male Sprague Dawley rats were studied for 10 weeks. The rats were randomly divided into a healthy control group (n=12) and 3 induced diabetic groups (n=12 each); the groups were either non-treated, treated with rapamycin, or treated with both rapamycin and metformin. At a set time of 3 weeks, 6 weeks, and 10 weeks urinary albumin ration as well as serum creatinine were obtained, and at least three rats were sacrificed. We used immunohistochemical staining of kidney tissue to study autophagy with LC3 antibody. We relied on Electron microscopy to measure GBM thickening and the degree of mesangial expansion. Results Compared to non-treated rats, diabetic rats treated with rapamycin alone or rapamycin and metformin showed a lower level of proteinuria and almost normal serum creatinine through all study intervals. Also, the histopathological analysis showed increased expression of LC3 in both treated and non-treated diabetic rat groups. There were no significant differences between both treated groups in levels of LC3 expression. At week 10, the mesangial expansion score was less in rats on combination therapy than in rats treated only with rapamycin. Conclusion Autophagy induction in DN ameliorates the clinical and pathological severity. Adding metformin to rapamycin seems to be of benefit in halting the pathological progression.","PeriodicalId":472816,"journal":{"name":"Journal of the Egyptian Society of Nephrology","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135798710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is online hemodiafiltration superior to hemodialysis in removal of indoxyl sulfate in chronic hemodialysis patients? A comparative study","authors":"MohamedSary Gharib, ImanIbrahim Sarhaan, MohamedSaeed Hassan, MarwaShaban Abd el samea, AmiraMohamed Mahmoud","doi":"10.4103/jesnt.jesnt_4_23","DOIUrl":"https://doi.org/10.4103/jesnt.jesnt_4_23","url":null,"abstract":"Background Indoxyl sulfate (IS) is a protein-bound small molecule that is poorly cleared by conventional hemodialysis and has potential toxicity. This study aimed to evaluate the superiority of online hemodiafiltration (HDF) over hemodialysis for the removal of IS in patients undergoing maintenance hemodialysis. Patients and Methods Sixty patients undergoing maintenance hemodialysis were enrolled in this prospective, randomized comparative study. Patients were randomly allocated to three groups: online post-dilution HDF, high-flux hemodialysis (HFHD), and low-flux hemodialysis (LFHD). Each group consisted of 20 patients. Serum total IS (tIS) levels were measured pre- and post-dialysis. The tIS removal rate was assessed by calculating the tIS reduction ratio (tISRR). Results Serum tIS levels decreased significantly after dialysis in all groups (all P < 0.001). The mean tISRR did not differ significantly between the HDF and HFHD (24.20 ± 10.73 vs. 19.70 ± 14.31%, P = 0.449) or between HFHD and LFHD (19.7 ± 14.3 vs. 13.5 ± 9.52%, P = 0.229). The ISRR for HDF was significantly higher than that for LFHD (24.2 ± 10.7 vs. 13.5 ± 9.52%, P = 0.015). Regression analysis did not show significant differences in ISRR between the HDF and HFHD groups, even after controlling for covariates (P = 0.160). Conclusion The study showed that online HDF had no additive effect on tIS removal compared to HFHD; however, it was superior to LFHD.","PeriodicalId":472816,"journal":{"name":"Journal of the Egyptian Society of Nephrology","volume":"88 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135798415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}