Salwa Ibrahim

Quality of care assessment and adherence to the international guidelines considering dialysis, water treatment, and protection against transmission of infections in university hospital‐based dialysis units in Cairo, Egypt

End‐stage renal disease has emerged as a major public health problem around the world. In recent decades, several important advances have been made in the therapy of hemodialysis (HD) with the introduction of international guidelines to ensure the delivery of optimum care to HD patients. An increased mortality risk in HD patients unable to meet six targets in different areas of HD practice has been reported by the Dialysis Outcomes and Practice Patterns Study investigators. In this retrospective study, we assessed the current practice patterns of care for HD patients in the Kaser El‐Aini Nephrology and Dialysis Center in comparison with Dialysis Outcomes Quality Initiative Guidelines, European Best Practice Guidelines, Centers for Disease Control and Prevention guidelines for prevention of transmission of infections among HD patients, and American Association for Medical Instrumentation (AAMI) standards for dialysis water quality. The mean percent of urea reduction was 63 ± 8.8% in prevalent HD patients. An arteriovenous fistula was the vascular access in 91% of prevalent HD patients, whereas a temporary catheter was used in 9% of cases mostly as a bridge till arteriovenous fistula creation/maturation. Bicarbonate was the base used in 80% of the cases. Ninty‐seven percent patients had thrice‐weekly sessions and 3% had two dialysis sessions/wk. The mean serum albumin was 4.19 ± 0.39 g/dL; 66.66% of prevalent patients had serum albumin level >4 g/dL. The mean serum calcium was 8.66 ± 1.4 mg/dL, phosphorus was 6.26 ± 2.54 mg/dL, and approximately 60% of patients had a serum phosphorus level >5.5 mg/dL. The CaxPi product was higher than 55 in around 40% of the cases, and the parathyroid hormone level was in the range of 150 to 300 pg/mL in around 10% of prevalent patients. The mean hemoglobin was 9.23 ± 7.18 g/dL in prevalent cases; around 70% of cases had a hemoglobin level <11 g/dL. Iron deficiency was prevalent as 18% of patients, with serum ferritin <200 ng/L, and 34% had total serum test <20%. Seventy percent of the patients were hepatitis C virus positive and 4% were hepatitis B surface antigen positive, and all were negative for the human immunodeficiency virus serological test. Dialysis water was monitored regularly for chemical and bacterial contamination as recommended by the American Association for Medical Instrumentation, but an endotoxin assay is currently not included in the monitoring checklist. The annual mortality rate was 8% in 2007. The current audit revealed a reasonable quality of care for HD patients in the fields of vascular access care, dialysis adequacy, and nutrition areas. It also reveals the need for improving anemia management and control of hyperphosphatemia with dietary counseling and more frequent dialysis. To fully meet the guideline targets, each patient should be treated in an individualized way with more counseling, nutritional education, and individualized dialysis prescription. Besides, the unit needs to adopt primary and secondary intervention strategies to prevent and promptly correct any deviation from the desired targets.

A five-year analysis of the incidence of glomerulonephritis at Cairo University Hospital-Egypt

Our study aimed to obtain a comprehensive review of the incidence of biopsy-proven glomerulonephritis (GN) at the Cairo University Hospitals, Egypt, over the last five years. We analyzed the clinical and pathological data of all renal biopsy samples that were performed during the period from July 2003 to July 2008. Renal biopsy samples of 924 patients were referred for pathological assessment during the period of the study [437 male and 487 female patients; their mean age was 26.5 ± 14.6 years (range: 2.5-71 years)]. Focal segmental glomerulo-nephritis was the most frequent cause of primary GN (21.21%), followed by mesangial proliferative GN (18.93%), diffuse proliferative GN (13.96%), focal proliferative GN (12.77%) and membranous GN (10.93%). The results could be explained by the high incidence of lupus nephritis among the study subjects as well as the relatively young age of the study group.

Evaluation of Renal Gene Expression of Protein Kinase C (PKC) Isoforms in Diabetic and Nondiabetic Proliferative Glomerular Diseases

The protein kinase C (PKC) family consists of 13 members categorized as conventional or novel depending on whether diacylglycerol, calcium, or phosphatidylserine is required for activation. High glucose leads to activation of different forms of PKC across tissue types, thus determining the kind of diabetes-induced organ damage. PKC β was reported to have a positive role in B-lymphocyte activity through activation of NF-κB, leading to various immune disorders. We examined renal expression of two PKC isoforms α and β in renal biopsies of patients with diabetic nephropathy, lupus nephritis (LN) (Class 3-4), and mesangioproliferative glomerulonephritis (MPGN) to explore the role of each isoform in different glomerular diseases. PKC α and β gene expression was studied by quantitative real-time reverse transcription-PCR in 20 patients with type 2 diabetes and proteinuria (serum creatinine 2.04 ± 0.85 mg/dl, 24-h urinary protein 3.61 ± 1.75 g, eGFR 37.85 ± 17.89 ml/min/1.73 m2), 20 patients with proliferative LN (serum creatinine 1.67 ± 1.50 mg/dl, 24-h urinary protein 4.46 ± 5.01 g, eGFR 69.62 ± 40.93 ml/min/1.73 m2), and 20 patients with MPGN (serum creatinine 3.32 ± 2.79 mg/dl, 24-h urinary protein 4.65 ± 4.11 g, eGFR 32.62 ± 29.56 ml/min/1.73 m2). Normal tissues from the normal pole of four kidneys removed because of renal tumor served as controls. PKC α gene expression was significantly increased in diabetic kidneys compared to LN and MPGN (316.95 ± 152.94 µg/ml vs. 185.97 ± 32.13 and 195.46 ± 46.45 µg/ml, p < 0.05). PKC β gene expression was significantly increased in the LN and MPGN groups compared to the diabetic nephropathy group (41.01 ± 14.03 and 39.93 ± 16.41 µg/ml, respectively, vs. 18.20 ± 4.91 µg/ml, p < 0.05). Significant correlation was noted between the PKC α gene concentrations and proteinuria in diabetic patients. Renal expression of PKC α and β genes in control tissues were significantly lower compared to diabetic kidneys, LN, and MPGN groups (32.31 ± 0.36 and 4.67 ± 2.41 µg/ml, respectively, p < 0.001). The study revealed enhanced renal gene expression of both PKC isoforms α and β in diabetic kidney tissues, LN, and MPGN, but in different patterns. PKC α gene expression was significantly increased in diabetic patients with chronic kidney disease. The increased expression of the PKC β gene in LN and MPGN highlights its role in regulation of the immune system. This may represent potential therapeutic targets for prevention of progressive kidney injury in diabetic and proliferative glomerular diseases.

Role of ZnS shell on stability, cytotoxicity, and photocytotoxicity of water-soluble CdSe semiconductor quantum dots surface modified with glutathione

Abstract. The present study examines the stability and cytotoxicity of two quantum dots (QDs) systems in cell culture medium in the presence and absence of a thin layer of a ZnS shell. The two systems were built from a core, CdSe, and surface modified with glutathione (GSH), named CdSe∼GSH and CdSe/ZnS∼GSH. CdSe/ZnS∼GSH QDs exhibited a high photostability with a pronounced enhancement in photoluminescence in cell culture medium. Both systems showed insignificant reduction in cell viability of HFB-4 and MCF-7 cell lines in the dark. Following 60 min of low laser power exposure (irradiance of 10  mW cm−2), CdSe∼GSH QDs showed a remarkable decrease in cell viability, which may result from the detachment of GSH molecules, whereas CdSe/ZnS∼GSH QDs showed an insignificant decrease either immediately after irradiation or even 2 h post-exposure, which can be attributed to the high affinity between ZnS and GSH coatings. This study demonstrated that a thin layer of ZnS shell played a crucial role in the stability of CdSe/ZnS∼GSH QDs in cell culture medium with an improvement in luminescence efficiency, whereas surface modification with GSH molecules in the presence of ZnS showed no significant cytotoxic effects before or after photoirradiation, which makes this system attractive for several biomedical applications.

The incidence of biopsy-proven glomerulonephritis in Cairo University, Egypt: a 5-year study

Sir, The incidence of biopsy-proven glomerulonephritis (GN) varies in different geographical areas and is affected by socio-economic conditions, race, differences in genetic susceptibility and environmental exposure. Recent studies suggested a changing pattern of incidence of GN in different parts of the world [1,2]. For instance, the incidence of end-stage renal disease (ESRD) as a result of focal segmental glomerulosclerosis (FSGS) has increased 11-fold in the past two decades in a recent study [2]. Our study aimed to obtain a comprehensive review of the incidence of biopsy-proven glomerulonephritis in Cairo University, Egypt, over the last 5 years. We analysed the clinical and pathological data of all renal biopsy samples that were obtained during the period from July 2003 to 2008. Age, gender, indication of renal biopsy and the pathological findings were recorded for analysis. A total of 924 renal biopsy samples were referred for pathological assessment during the period of the study. The monthly incidence of biopsy-proven GN was 15.4 (range 13–19). Proliferative GN was reported in 497 cases (53.78%) and non-proliferative GN was reported in 427 cases (46.22%). Lupus nephritis was reported in 264 cases (28.57%). The female/male ratio was 221/41, 70% of lupus patients aged 18–45 years and 85% had renal impairment (mean serum creatinine was 3.21 ± 4.09 mg/dl). The common glomerular pathologies in patients with lupus nephritis were the proliferative classes II–IV (28.78, 30.30, 27.65%, respectively). Morphologically, FSGS was the most frequent cause of GN (21.21%) followed by mesangial proliferative GN (18.93%), diffuse proliferative GN (13.96%), focal proliferative GN (12.77%) and membranous GN (10.93%) (Table ​(Table1).1). In females, mesangial proliferative, focal proliferative GN and diffuse proliferative GN were the predominant pathological findings, and in males FSGS, diffuse proliferative GN and mesangial proliferative GN were predominant. In those aged <18, mesangial proliferative GN, minimal change disease and FSGS were more prevalent compared to adults. Figure ​Figure11 shows the frequency of GN in patients with renal insufficiency. Fig. 1 Incidence of GNs in patients with renal insufficiency [352 cases (38.09%)]. We conclude that FSGS and proliferative GN (SLE and others) were the predominant forms of GN in the population of the study. Compared to other Arab countries, FSGS was the predominant ... Table 1 Incidence of biopsy proven GNs in the study group Conflict of interest statement. None declared.

Screening of incidental kidney disease in normoglycemic, normotensive healthy adults

Background and aim Chronic kidney disease is a major public health problem with increased global incidence and prevalence, especially in Egypt, poor quality of life, and high risk of morbidity and mortality. The aim of the work was to determine the prevalence and the risk factors of incidental kidney diseases among apparently healthy adults. Patients and methods A total of 300 healthy normotensive and normoglycemic individuals were assessed for creatinine, proteinuria, and glomerular filtration rate, with correlation to their BMI and systolic and diastolic blood pressures. Results Microalbuminuria was positively correlated to age, BMI, and systolic blood pressure, with a significant P-value of less than 0.001. Conclusion The prevalence estimates and risk factors for those with microalbuminuria as a marker of occult renal disease include age, BMI, high systolic blood pressure, and family history of renal problems.

Spectrum of renal diseases among patients admitted to the internal medicine unit through the emergency room and their outcomes: morbidity, mortality, and cost analysis

Renal disease is a common health problem that is linked to excessive morbidity and mortality worldwide. It is crucial to know the etiology and clinical features of renal diseases to promote prevention strategies and adequate management resources. This study aimed to perform a comprehensive review the spectrum of renal diseases among patients admitted to one internal medicine unit (unit 6) through the emergency room. We evaluated total admission cases to the unit 6 through the emergency room in 1 year between July 2010 and July 2011. The total capacity of the unit is 24 beds. The total number of patients admitted during the study period was 571. Their mean age was 50.72 ΁ 14.15 years (range 14-95 years). A total of 51.66% were males and 48.44% were females. The average duration of hospital stay was 6.43 ΁ 3.57 days (range 1-30 days). There were 200 patients with renal diseases (35.02%). Their mean age was 46.73 ΁ 15.76 years (range 16-87 years). In all, 55% were females and 45% were males, and the average duration of hospital stay was 7.59 ΁ 3.89 days (range 1-23 days). In all, 33% of patients had acute kidney injury represented, 51.5% had chronic kidney disease, 7.5% had glomerular diseases (nephrotic and nephritic syndromes), and 8% had obstructive uropathy. Fifteen patients died during their hospital stay (7.5%); their average age was 49.87 ΁ 11.42 years (range 28-65 years). There were four statistically significant mortality predictors among patients with kidney diseases (total leukocyte count above 19.55 cm 2 , serum potassium above 5.74 mEq/l, atrial fibrillation, and hypertension). The total cost of services provided for patients was 275 624 L.E. The total cost of services provided for patients with kidney diseases was 118 919.25 L.E. (43.15%).

Late initiation of dialysis in diabetic Egyptian patients

Introduction The number of chronic kidney disease (CKD) patients has been increasing over the past two decades, both globally and in Egypt. In our current study we tried to identify the pattern of end-stage renal patients [chronic kidney disease stage 5 (CKD5)], who presented at a tertiary referral center (Cairo University Hospital, Kasr-Alainy School of Medicine), to identify the epidemiological characteristics, clinical presentation, hospital course, and outcome. Patients and methods This is a prospective analysis of all medical admissions through the emergency department (Department 6) of Kasr-Alainy School of Medicine, Cairo University, in 1 year from July 2010 to July 2011. We included patients with proven CKD 5 who needed to be started on renal replacement therapy. Results A total of 571 patients were identified, of whom 82 patients (36 males and 46 females) proved to have CKD5 and needed to be started on renal replacement therapy. The mean age of the included patients was 51.63 ΁ 14.7 years. Oliguria and vomiting were the most frequent symptoms, as seen in 52 cases (63.4%), followed by symptoms of volume overload in 24 patients (29.3%) and disturbed level of consciousness and fever in six patients (7.3%). Diabetic nephropathy was the most common cause of renal failure in our studied cohort (51.2%), followed by hypertension (22%); the cause was unknown in 25% of patients. Four patients (4.9%) died during their hospital stay. Conclusion In conclusion, our study showed that there is delayed referral for nephrology care and delayed initiation of dialysis when patients presented through the emergency department. Of particular interest was the fact that diabetic patients were most often subjected to this practice.