Khaled El-Dahshan

Prognostic value of serum creatinine levels in children with posterior urethral valves treated by primary valve ablation

PURPOSE We evaluated the prognostic value of serum creatinine level at presentation and nadir creatinine during follow up for future renal function (RF) in children with posterior urethral valves (PUV). MATERIALS AND METHODS Between 1987 and 2004, 120 cases of PUV were treated initially at our hospital with valve ablation. Initial assessment included serum creatinine measurement, urine analysis and culture, renal ultrasonography and voiding cystourethrography. After valve ablation, renal ultrasound and serum creatinine measurement were repeated and thereafter during visits until the end of follow up. RESULTS Follow up ranged from 2 to 12 years (mean=4.4). Renal insufficiency (RI) developed at the end of follow up in 44 patients (36.5%). The mean initial and nadir serum creatinine in the RI group was higher than in the normal RF group (P<0.05). With a cut-off value of 1mg/dl for initial and nadir serum creatinine, the incidence of RI was significantly different (P<0.05). CONCLUSION Our data confirm the high prognostic value of nadir serum creatinine after relief of valvular obstruction. Further, the serum creatinine level before valve ablation correlates significantly with long-term RF in children with PUV.

Prevention of chronic cyclosporine nephrotoxicity in Sprague Dawely rats: role of colchicine and omega-3-fatty acids

Initial enthusiasm with the first use of cyclosporine (Cs) in humans has been tempered by its propensity to induce nephrotoxicity, in particular, a chronic and progressive form culminating in renal failure [1]. A variety of potential mediators have been proposed to account for the characteristic intrarenal vasoconstriction associated with this agent. colchicine was applied with some success in the short-term prevention of renal fibrosis in experimental glomerulonephritis [2]. Meanwhile, daily oral ingestion of omega-3-fatty acids resulted in a rise in glomerular filtration rate, effective renal plasma flow and a drop in mean arterial blood pressure and total renal vascular resistance [3]. Thus, we compared the protective effects of colchicine versus omega-3-fatty acids in prevention of chronic Cs nephrotoxicity in experimental model. A total of 60 male Sprague Dawely rats were divided into four groups of 15 animals each. Group 1: received olive oil. Group 2: received Cs orally (100 mg/kg). Group 3: were given daily colchicines (30 (g/kg) in addition to Cs. Group 4: were given omega-3-fatty acids daily (100 mg/kg body weight) in addition to Cs. At the starting point and every other week thereafter, all animals were subjected to blood sampling and analysis for serum creatinine, sodium, potassium, and Cs whole blood trough levels. Around 80 days after initiation of treatment, animals were sacrificed. The kidneys were removed, processed for light microscopic examination and immunohistochemical staining for cytoskeletal proteins. At the end point, there were no significant differences neither in serum, urinary parameters nor Cs whole blood levels among the different groups. Histopathological assessment of Cs-treated animals showed significant changes in the form of tubular atrophy, interstitial fibrosis and chronic inflammatory cells infiltration, mainly in the outer medulla. Cortical changes were minor located mainly in the medullary rays. Changes in the inner medulla were significantly higher in Cs group compared to colchicine and omega-3 treated groups; however, inflammatory cell infiltration in the outer medulla were comparable in the latter two groups. These changes were significantly higher in omega-3-fatty acid group than in colchicine group, while inflammatory cell infiltration A. Sabry (&) Æ K. El-Dahshan Æ A. El-Hussieni Nephrology and Internal Medicine Department, Mansoura Urology and Nephrology center, Mansoura University, Mansoura, Egypt e-mail: asabry20@yahoo.com Int Urol Nephrol (2007) 39:271–273 DOI 10.1007/s11255-006-9061-1

Effect of HCV infection on hematocrit and hemoglobin level in Egyptian hemodialysis patients.

The prevalence of HCV infection in patients undergoing dialysis is persistently greater than that in the general population [1]. It is endemic in hemodialysis (HD) units around the world, predominantly in Mediterranean and developing countries of the Middle and Far East. Nosocomial transmission of HCV has been reported to be the major route of HCV infection in modern hospital dialysis units. Anemia is the most common hematological abnormality in chronic renal failure. In the past, blood transfusion was the essential method in the treatment of renal anemia, whereas the transfusion requirement has recently lessened by the use of erythropoietin (EPO). It is known that there is a relationship between iron stores and HCV infection. However, the influence of HCV infection upon potential iron and erythropoietin therapy is controversial. High serum ferritin level and hepatosteatosis are frequently seen among patients with HCV infection. However, it is not clear whether HCV infection causes iron accumulation or increased iron storage facilitates HCV infection. Erythropoietin requirements and levels in patients with HCV positive (+) and HCV negative (-) was reported to be different in patients with ESRD. In view of the recently published data reporting higher hemoglobin and hematocrit levels in HCV+ compared to HCVHD patients, we decided to compare these values in our patients. Ninety-nine patients (68 male, 31 female, mean age 42.81 ± 16.63 years, 70 patients were HCV+ and 29 were HCV-) receiving chronic hemodialysis for at least one year in Mansoura Urology and Nephrology Center hemodialysis units were retrospectively studied (The Demographic, clinical and laboratory parameters are given in Table 1). AntiHCV determinations were performed in all patients by third generation enzyme—linked immunosorbent assay. HCVRNA was confirmed in all positive patients by nested polymerase chain rection (PCR) carrid out with primers located with the 5‘NC region of HCV-genome (Amplicor, Roche, Branchburg, NJ, USA) and repeated every 3 months. Anti-HCV antibodies, Hepatitis B surface antigen and antibody and antibodies to Human Immunodeficiency virus 1 and 2 were done on quarterly bases. All patients were subjected to monthly biochemical analysis—samples were withdrawn from the patients before hemodialysis—for: Serum sodium, potassium, uric acid, fasting blood sugar, uric acid, cholesterol, triglycerides, liver function test and complete blood count. A. A.-A. Sabry (&) K. F. El-Dahshan K. M. Mahmoud A. A El-Husseini Nephrology and Internal Medicine Department, Mansoura University, Mansoura Al Ghomhoria, 35555, Egypt e-mail: asabry20@yahoo.com

Safe conversion of mycophenolate mofetil to azathioprine in kidney transplant recipients with sirolimus-based immunosuppression

Aim:  Mycophenolate mofetil (MMF) is a powerful immunosuppressive drug with established efficacy and safety. The long‐term use of MMF may bring increased risk of for infection and malignancy and also increased cost of transplantation. The search for minimization of immunosuppressive protocol has led to an open randomized clinical trial of conversion from MMF to azathioprine (AZA).

Detection of Hepatis C Virus-Related Immunologic Markers and Their Impact on Outcomes of Living-Donor Kidney Transplant Recipients

OBJECTIVES Liver disease is an important cause of morbidity and mortality among recipients of transplanted organs. In addition to the liver, hepatitis C virus infection has a significant prevalence among recipients of kidney transplant and is related to worse graft and recipient survival as the kidney is an important component of the hepatitis C virus clinical syndrome. MATERIALS AND METHODS This retrospective single center study included 336 patients with end-stage renal disease who received a kidney transplant at the Mansoura Urology and Nephrology Center from January 1992 to December 1995. Of 336 patients, 63 were excluded, and the remaining 273 patients were divided into 3 groups: viremic active (72 patients), viremic inactive (108 patients), and nonviremic (93 patients). Division of patients was based on hepatitis C virus RNA complement level (C3 and/or C4 consumption), circulating cryoglobulins, and rheumatoid factor detection. RESULTS Our study showed insignificant differences regarding patient characteristics and demographic data among the study groups but significantly higher incidence of transaminitis in viremic (active and inactive) patients. Nonsignificant differences were found regarding proteinuria among the 3 groups, including among those who had levels in either nephrotic or nonnephrotic ranges. Biopsy-proven acute rejection episodes among the 3 groups of recipients were statistically comparable, with significantly higher frequency of chronic rejection episodes among viremic active patients. Nonviremic recipients had significantly lower serum creatinine levels than viremic (active and inactive) recipients. Patient and graft survival results were comparable among the groups. CONCLUSIONS Presence of hepatitis C virus immunologic markers does not have a significant effect on patient and graft survival; however, it may be a clue for long-term incidence of chronic rejection.