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   Table of Contents - Current issue
July-September 2018
Volume 18 | Issue 3
Page Nos. 59-102

Online since Friday, November 9, 2018

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Prevalence of diabetic kidney disease before and after renal transplantation in Arab countries p. 59
Osama Gheith, Nashwa Othman, Aymen Maher, Suzann Rida, Medhat A Halim, Heba Abduo, Torki Al-Otaibi
Introduction The Arab world contains 22 countries with a total population of 362.5 million people. The prevalence of diabetes around the world has reached epidemic proportions. It already affects nearly more than 350 million people and is predictable to grow to more than 550 million people by 2035. The prevalence of diabetic kidney disease (DKD) in Arab countries is not well studied. The aim of the study was to review and present the prevalence of DKD among the Arabian population. Materials and methods We reviewed most of the published data − since the 1980s − in different Arabic countries regarding the prevalence of diabetes and DKD. Results The Arab countries with the highest prevalence of T2DM are: the Kingdom of Saudi Arabia (31.6%), Oman (29%), Kuwait (25.4%), Bahrain (25.0%), and the United Arab Emirates (25.0%). The lowest prevalence was found in Mauritania (4.7%) and Somalia (3.9%). Arab countries with high prevalence of micro-albuminuria included UAE, KSA, Bahrain, and Lebanon while KSA, Kuwait, Bahrain, and Egypt represented countries with the highest prevalence of macro-albuminuria. Low prevalence of DM and DKD was found in Iraq and Tunisia. These differences could be attributed to the genetic predisposition and the change in lifestyle. The cumulative incidence of PTDM at 12 months post-transplant was 17.6% in Sudan, 27% in KSA, 27% among the Egyptian liver transplants, 22.2% among the Egyptian kidney recipients, and 33% in Bahrain. There is no data available regarding diabetic kidney disease in renal transplant recipients in Arab countries. Conclusion Diabetic nephropathy is not an uncommon complication of diabetes (types 1 and 2) in Arab countries. Rapid economic growth in some Arabic speaking countries improved the infrastructure, but carries with it the burden of risk factors of DM. Large prospective collaborative studies are critically needed to explore this medical and socioeconomic problem among the Arab people before and after renal transplantation.
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Native nephrectomy in kidney transplantation, when, why, and how? p. 68
Mohamed E Elrggal, Hoda M.M Abd Elaziz, Mohammed A Gawad, Hussein A Sheashaa
Native nephrectomy (NN) is not routinely performed in the context of kidney transplantation. Certain clinical circumstances necessitate performing NN such as large polycystic kidneys impairing patient’s quality of life and hindering graft implantation. NN may be done either before, simultaneously with, or after kidney transplantation. Although several studies have reported the potential benefits of the pretransplantation approach, others defended the simultaneous approach postulating that it is feasible and satisfactory. Nevertheless, still the ideal timing of NN is not settled, and several factors determine the choice of nephrectomy timing, including the presence of pressure symptoms, residual diuresis, and adequate space for the graft and living (not deceased) kidney donation. Answering these questions will help in decision making to attain an individualized approach that would help in achieving optimum timing of NN in relation to kidney transplantation.
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The role of adrenomedulin and leptin in type 2 diabetes mellitus: can be used as early predictors for its microvascular complications? p. 73
Effat A.E Tony, Manal El Eldeen, Abeer A Tony, Tahra El-Shereif, Madleen A.A Abdou
Background Microvascular vasodegeneration is the major factor in progression of diabetic complications. Adipocytokines secrete a variety of hormones and cytokines, which contribute to the development of vascular and renal diseases. Elevated levels of leptin are observed in chronic renal failure and hypertension. Adrenomedulin (AM), with its antiproliferative effects, is considered as an associated factor in the course of vascular and diabetic insults. However, there is lack of knowledge about the precise role, regulation, production and release at the systemic level of AM, and its correlation with the peripheral blood flow in diabetic vascular insult. Aim We aimed to assess the levels of AM and leptin in type 2 diabetes mellitus (T2DM) patients, to assess their correlations with glycemic control and microvascular complications, and to assess whether these levels vary with the stage of diabetic nephropathy (DN). Patients and methods This is a prospective study including 100 T2DM patients, aged 32–48 years old. Patients were classified into two groups according to albuminuria (group A) and according to estimated glomerular filtration rate (group B). Participants were subjected to history taking, and clinical and fundus examinations. Peripheral hemogram, liver and kidney function tests, lipogram, glycosylated hemoglobin, urine albumin/creatinine ratio, serum leptin and AM were performed. They also underwent ECG and transthoracic echocardiogram. Results The levels of leptin and AM were significantly higher in T2DM patients with microvascular complications than in those without (P<0.001 for each). Leptin and AM levels were progressively elevated in all stages of DN, and the increment was dependent on the severity of DN (P<0.001, for each). There was a significant correlation between AM levels and glycosylated hemoglobin among diabetic patients with microvascular complications. Multivariate logistic regression analysis showed that the odds ratio for the presence of DN in the highest leptin was 4.1 (95% confidence interval: 3.88–5.03, P=0.001); therefore, leptin was an independent risk factor for DN. Conclusion AM and leptin play a role in the pathogenesis of microvasculopathy in T2DM patients. An increased AM and leptin level correlates with poor metabolic control.
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The role of furosemide stress test in the prediction of severity and outcome of sepsis-induced acute kidney injury p. 86
Hesham K Elsaegh, Yasmine S Naga, Hany E.M Elsayed, Ahmed M Abd Elhalim Elbasha
Introduction Acute kidney injury (AKI) is a common complication of sepsis in ICU patients. No test has been shown to definitively predict its occurrence and progression to more severe stages. The aim of the study was to investigate the ability of furosemide stress test (FST) to predict the development and progression of AKI in critically ill patients, and to compare it to the level of serum cystatin C. Patients and methods We studied 60 patients who were subdivided into four groups: each group included 15 patients who had normal renal functions, AKI stages 1, 2, and 3, respectively. Clinical, laboratory, and therapeutic data were collected. Serum cystatin C levels were assessed by the enzyme-linked immunosorbent assay technique and FST (at a dose of 1.0 or 1.5 mg/kg according to previous furosemide exposure) was performed for each patient with assessment of their urine output during the following 2 h. Results In our study, we compared the ability of FST to predict the progression of AKI in each stage. The sensitivity of FST to predict the outcome of AKI was 89.29% and its specificity was 93.75%, while the sensitivity of serum cystatin C to predict the outcome was 82.14% and its specificity was 31.25% with area under the curve=0.742. Conclusions The FST in patients with early AKI serves as a cheap, easily available tool to assess tubular kidney function with prognostic capacity to assess the occurrence and the progression of AKI in septic ICU patients.
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Beta-trace protein as an early predictor of diabetic nephropathy in type II diabetes p. 96
Hayam A Hebah, Essam N Afifi, Shaimaa Z Abd El-Megeid, Mai M Al-Raddad
Background Diabetic nephropathy (DN) represents the leading cause of end-stage renal disease worldwide. Albuminuria is still the standard for diagnosis of DN, although it is limited by the fact that structural damage might precede albumin excretion. So, new biomarkers are needed to predict DN even in patients with normoalbuminuria. Aim To assess serum beta-trace protein (BTP) level and its possible role in early detection of DN. Patients and methods This is a prospective cohort study carried on 40 type II diabetic patients with urinary albumin/creatinine ratio less than 30 mg/g and 10 healthy nondiabetic controls without renal disease. Serum BTP and urinary albumin/creatinine ratio were measured for all participants at selection and after 3 months. Results BTP was significantly higher at selection time in 32/40 (80%) diabetic patients, with median (interquartile range) values of 410 (312.5) ng/ml when compared with controls, with median (interquartile range) of 200 (110) ng/ml (P<0.001). BTP at a cutoff value of 260 ng/ml for the detection of DN, with area under curve of 0.848 and 95% confidence interval of 0.726–0.969, had 80% sensitivity, 80% specificity, 94.1% positive predictive value, and 50% negative predictive value. After 3 months, BTP increased in diabetics to 440 (502.5) ng/ml, with P value of 0.867, and increased in controls to 275 (115) ng/ml, with P=0.007. After 3 months, BTP level positively correlated with blood urea in diabetics (r=0.321, P=0.043). Conclusion Serum BTP is a predictive marker of DN with high sensitivity and specificity. It detects renal injury earlier than albuminuria. Further studies are needed to assess its relation to glycemic control and disease progression.
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