Hussein Sheashaa

Evaluation of fluoroquinolones for the prevention of BK viremia after renal transplantation.

BACKGROUND AND OBJECTIVES Nearly 30% of renal transplant recipients develops BK viremia, a prerequisite for BK nephropathy. Case reports have evaluated treatment options for BK virus, but no controlled studies have assessed prophylactic therapies. Fluoroquinolone antibiotics were studied for prevention of BK viremia after renal transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This retrospective analysis evaluated adult renal transplant recipients with at least one BK viral load (blood) between 90 and 400 days after transplantation. Six to 12 months of co-trimoxazole was used for Pneumocystis prophylaxis. In sulfa-allergic/-intolerant patients, 6 to 12 months of atovaquone with 1 month of a fluoroquinolone was used. Fluoroquinolones can inhibit BK DNA topoisomerase. The two groups studied were those that received 30 days of levofloxacin or ciprofloxacin after transplantation and those that did not. The primary endpoint was BK viremia rates at 1 year. Of note, of the 160 patients not receiving fluoroquinolone prophylaxis, 40 received a fluoroquinolone for treatment of a bacterial infection within 3 months after transplantation. Subgroup analysis evaluating these 40 patients against the 120 who had no exposure to fluoroquinolones was completed. RESULTS A 1-month fluoroquinolone course after transplantation was associated with significantly lower rates of BK viremia at 1 year compared with those with no fluoroquinolone. In the subgroup analysis, exposure to fluoroquinolone for treatment of bacterial infections within 3 months after transplantation was associated with significantly lower 1-year rates of BK viremia. CONCLUSIONS This analysis demonstrates that fluoroquinolones are effective at preventing BK viremia after renal transplantation.

Echocardiographic changes and risk factors for left ventricular hypertrophy in children and adolescents after renal transplantation

Abstract:  Long‐term consequences of cardiac alteration in children with chronic renal failure and after renal transplantation are largely unknown. In chronic uremia, cardiomyopathy manifests itself as systolic dysfunction, concentric left ventricular hypertrophy (LVH) or left ventricular dilatation. The correction of uremic state by renal transplantation leads to normalization of left ventricular contractility, regression of LVH and improvement of cavity volume and so dialysis patients with uremic cardiomyopathy would benefit from renal transplantation. We studied 73 patients, aged 17 yr or less, who underwent renal transplantation in our center. This cross‐sectional study was performed 4.6 yr (median) after transplantation. Of the total, 48 were males and 25 were females. Transthoracic echocardiographic examination was performed for all cases. The effects of clinical, demographic, biochemical and therapeutic data on echocardiographic parameters were assessed. Multivariate analysis was used to assess the relation between the risk factors and the left ventricular muscle mass index. The most common echocardiographic abnormalities were the LVH (47.9%), left atrial enlargement (31.5%) and left ventricular dilatation and systolic dysfunction (13.7% for each). The pretransplant dialysis, arteriovenous fistula, acute rejection, cumulative steroid dose per square meter surface area, post‐transplant hypertension, anemia and graft dysfunction were significant risk factors for LVH by univariate analysis. The significant factors by multivariate analysis were pretransplant dialysis, post‐transplant hypertension and anemia. From this study we may conclude that LVH is a common problem among renal transplant children and adolescents. Early transplantation, control of hypertension and correction of anemia may be beneficial regarding left ventricular function and structure.

Epidemiology, pathophysiology, management and outcome of renal dysfunction associated with plasmodia infection

Malaria remains a serious health problem in many parts of the world. It causes high morbidity and claims many lives in developing countries each year. Humans are generally infected by four species of malaria parasites. However, malaria infection caused by Plasmodium malariae or P. falciparum is recognized as an important cause of acute renal failure (ARF) and other renal-related disorders (nephropathy) in infected patients. The increasing incidence of malarial ARF (MARF) and the emergence of clinical malarial infection after renal transplantation represent a serious challenge. Additionally, the impact of immunosuppressive therapies on malarial infection is intricate, complex, and not yet well defined. Pathogenesis of MARF is most likely to be due to immune complex-mediated glomerulonephritis caused by immune-complex deposition and endothelial damage, which may lead to fatal forms of quartan malarial nephropathies. Effects of mechanical, immunologic, cytokine, humoral, acute phase response, and hemodynamics factors in inducing malarial nephropathy have also been postulated. Development of preventive strategies aimed at combating MARF and other renal disorders associated with malaria infection requires (1) prevention of malarial infection, (2) early diagnosis, and (3) early referral to well-equipped centers to provide renal replacement therapy, if necessary, along with antimalarial therapy and support. These measures could significantly reduce mortality and enhance recovery of renal function.

Decline of viral hepatitis prevalence among asymptomatic Egyptian blood donors: A glimmer of hope

BACKGROUND Viral hepatitis is an important etiological agent of chronic hepatitis and liver disease and is a major cause of morbidity and mortality especially in Egypt since it has the highest prevalence of hepatitis C virus (HCV) infection. We aimed to assess if there is any change in the annual seroprevalence of both HCV and hepatitis B virus (HBV) infection in Egypt in the current era. METHODS Our study included 55,922 potentially healthy asymptomatic blood donors; 52,280 males and 3642 females with mean age of 30.98+/-8.6 years. All of them were volunteers for the first time and 70% were from rural areas. We applied our own questionnaire that included past medical history, surgical history, and history of blood donation. We screened their sera for the presence or absence of anti-HCV antibodies with the 3rd generation enzyme-linked immunosorbent assay (ELISA) and the presence or absence of hepatitis B surface antigen (HBsAg) with ELISA. RESULTS The cumulative seroprevalence of HCV and HBV infection was 11.95% and 1.3% respectively. The annual seroprevalence of both viruses showed a declining pattern throughout the study period from 17.7% to 7.4% regarding HCV and HBV infection from 2.3% to 0.9%. The decline trends for both viral infections were observed for both genders. CONCLUSION This study carries a glimmer of hope because of a decline in seroprevalence of viral hepatitis in Egypt. However stringent implementation of infection control programs in Egypt is mandatory to face this furious health problem.

Correlation between levels of TNF-α and IL-6 and hematological involvement in SLE Egyptian Patients with lupus nephritis

BackgroundSystemic lupus Erythematosus (SLE) is a rheumatic autoimmune disease characterized by multisystem organ involvement and by high titers of auto antibodies against several nuclear and cytoplasmic antigens. Numerous abnormalities of the cytokine network have been described in patients suffering from SLE. However the role of cytokines in different organ involvement is not yet well defined.ObjectiveTo determine if levels of Interlukin-6 (IL-6) and Tumor necrosis factor (TNF-α) correlate with SLE disease activity in Egyptian SLE patients and more specifically with hematological involvement.MethodsLevels of TNF-α and IL-6 in serum samples from sixty individuals (40 with Systemic lupus Erythmatosus and 20 healthy controls) were determined and renal biopsies were obtained from SLE patients.ResultsLevels of TNF-α and IL-6 were higher in SLE patients with active compared with inactive hematological disease. Further analysis showed that this association was dependent on inverse correlation (P=0.017, r=−0.49) for IL-6 and (P=0.76, r=−.243) for TNF-α. The mean level of TNF-α and Il-6 was (766.95±357.82 pg/ml) and (135.4±54.23 pg/ml) respectively for patients with active disease while it was (314.01±100.87 pg/ml) and (47.33±18.61 pg/ml) for those with inactive disease and (172.7±39.19 pg/ml) and (21.15±10.99 pg/ml) for the healthy control group respectively. The difference was statistically significant (P=0.002). We found significant positive correlations between TNF-α and IL-6 and the SLE Disease Activity Index (SLEDAI) score. (r=+0.743 and +0.772 respectively).ConclusionRaised level of Il-6 and TNF-α may influence the development of anemia in Egyptian patients with Lupus Nephritis.

Acute postinfectious crescentic glomerulonephritis: clinicopathologic presentation and risk factors.

Background: Glomerular crescent formation is a feature of the most severe forms of human glomerulonephritis. The postinfectious form of rapidly progressive glomerulonephritis with crescents is a form of immune complex glomerulonephritis which seem to have a better prognosis. A relatively poorer prognosis for crescentic postinfectious glomerulonephritis in South Africa has been reported. In the present study, we have tried to determine the mode of presentation, and the prognostic factors for renal and patient outcome for cases with postinfectious crescentic glomerulonephritis (CGN). Methods:Between 1990 and 2000 a total number of 128 patients with CGN were managed at our center, among them 23 cases were diagnosed as postinfectious CGN. They were followed-up for a mean period of 40.1 ± 28.9 months. Among them 12 were males and 11 were females. The median age was 12.35 years (range 4–55 years). The median serum creatinine at presentation was 7.24 mg/dl (range 1.3–14.5 mg/dl). We studied the clinical, laboratory and histopathological data .of our cases and their impact on the renal and patient outcome. Results:By univariate study the risk factors for renal dysfunction were the age, hypertension, and nephrotic range proteinuria during the follow-up period. By multivariate analysis only the, hypertension, and presence of nephrotic range proteinuria during the follow-up period were the significant risk factors. The risk factors that significantly affected patient mortality were hypertension and serum creatinine at last follow-up. Conclusion: postinfectious CGN is a severe form of glomerulonephritis that usually presents with rapidly progressive renal failure. The persistence of hypertension and nephrotic range proteinuria during the follow-up are major bad prognostic predictors for renal dysfunction.

Does aflatoxin as an environmental mycotoxin adversely affect the renal and hepatic functions of Egyptian lactating mothers and their infants? A preliminary report.

Backgrounds/Aims Aflatoxin as a mycotoxin constitutes a real human threat. Its presence in human milk was previously reported in different countries. This work is the first Egyptian report that aimed to assess the presence of aflatoxin in both mothers’ milk and the infants’ sera and studied its correlation with infants’ kidney functions.MethodsFifty healthy breast lactating mothers and their infants who were exclusively breast fed for at least 4 months were included. All of them were subjected to thorough laboratory evaluation including determination of aflatoxin concentration by high performance liquid chromatography.ResultsTwenty-four mothers (48%) and their infants had been contaminated with aflatoxin with the following mean contamination levels (ng/ml); mothers’ serum of 8.9±4.2, mothers’ milk of 1.9±0.6 and infants’ serum of 1.8±0.9. The presence of this contamination level is not associated with renal or hepatic dysfunction.ConclusionMothers and their infants in our locality showed a relatively high aflatoxin contamination rate. We did not find a correlation of this contamination level and either renal or hepatic dysfunction.

Efficacy and safety of Monascus purpureus Went rice in children and young adults with secondary hyperlipidemia: A preliminary report

BACKGROUNDS/AIMS Nephrotic dyslipidemia is a risk factor for development of systemic atherosclerosis; also it may aggravate glomerulosclerosis and enhance progression of glomerular disease. We aimed to assess the efficacy and safety of Monascus purpureus Went rice vs. fluvastatin therapy in the management of nephrotic dyslipidemia. METHODS Seventy-two patients with idiopathic persistent nephrotic syndrome with secondary dyslipidemia were included. They were randomly allocated into 3 - age and sex - matched groups. The first group comprised of 20 cases and were given Monascus purpureus Went rice, second group comprised 30 cases were given fluvastatin. The remaining 22 received no anti-dyslipidemic therapy and constituted a control group. All of these patients were subjected to thorough laboratory investigations including renal function tests, lipogram and neurological assessment. RESULTS Our results showed that both fluvastatin and Monascus purpureus Went rice were well-tolerated with no significant side effects. Both of them significantly reduced cholesterol after 6 months and 1 year. In comparison to baseline values, fluvastatin achieved a significant and progressive reduction of serum cholesterol by 35%, 38% and 42% at 3 months, 6 months and after 1 year respectively (p<0.001). Similar reductions were observed in the Monascus purpureus Went rice group. After one year we observed that serum cholesterol was significantly lower in statin and Monascus purpureus Went rice groups compared to the control group. CONCLUSION Monascus purpureus Went rice is safe, effective cholesterol lowering agent for nephrotic dyslipidemia both in adults and children.

Use of Nandrolone Decanoate as an Adjuvant for Erythropoietin Dose Reduction in Treating Anemia in Patients on Hemodialysis

Background/Aims: Use of androgen as an adjuvant therapy to treat anemia in patients on hemodialysis is debated. Our target is to assess the safety and the efficacy of nandrolone decanoate (ND) as an effective adjunctive therapy to treat such anemia. Methods: This study included 32 anemic adult hemodialysis patients who had adequate iron stores. They were randomized into two equal groups: the first group received subcutaneously a low dose of erythropoietin (EPO) 1,000 U three times weekly combined with ND, 50 mg intramuscularly twice weekly, and the second group received only the same low dose of EPO for the 6-month study period. All patients were subjected to a serial follow-up of hemoglobin (Hb), hematocrit % (Hct%), iron store indices, serum insulin-like growth factor-1 (IGF-1) concentration and liver function tests. Results: A significant rise of both Hb and Hct in both groups was found at the end of the study (p < 0.001). Although the rise of both Hb and Hct was higher in the androgen group, it was not rated as being statistically significant. Both groups showed a significant rise of serum IGF-1 concentration at the end of the study in comparison to its initial value. Moreover, the androgen group attained a more statistically significant rise of IGF-1 serum concentration. Four female patients discontinued ND because of related adverse effects, principally distressing hirsutism and hepatic dysfunction. Conclusion: Addition of ND to a low-dose EPO regimen does not offer a significant benefit. Androgen-related side effects limit its use in female patients.

Long-Term Evaluation of Basiliximab Induction Therapy in Live Donor Kidney Transplantation: A Five-Year Prospective Randomized Study

Background/Aims: The long-term evaluation of basiliximab induction therapy has not been addressed yet. We aim to evaluate its long-term effects in living related donor kidney transplantation. Methods: 100 adult recipients with their first kidney allograft were randomized into two treatment groups – one group received basiliximab and the second served as a control. All patients received a maintenance triple immunosuppressive therapy (steroids, cyclosporine microemulsion and azathioprine) and were closely followed for 5 years. Results: Basiliximab significantly reduced the proportion of patients who experienced an acute rejection in the first year (18/50) when compared to the control group (31/50) and in 5 years (27/50) when compared to (36/50) the controls. The cumulative steroid dose used throughout the study was significantly lower in the basiliximab group. The overall incidence of post-transplant complications was comparable between the two treatment groups. There was no significant difference in patients and graft survival; 5-year patient and graft survival were 100 and 86% for basiliximab, and 96 and 88% for the control group respectively. Conclusion: Although routine basiliximab induction significantly reduces the incidence of acute rejection, its beneficial long-term effects on graft function and patient and graft survival are not yet evident.