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Diabetic kidney disease: difference in the prevalence and risk factors worldwide
Osama Gheith, Nashwa Othman, Naryanan Nampoory, Medhat A Halimb, Torki Al-Otaibi
July-September 2016, 16(3):65-72
Diabetic nephropathy, which is defined as elevated urine albumin excretion or reduced glomerular filtration rate or both, is a serious complication that occurs in 20–40% of all diabetic patients. In this review, we try to highlight the prevalence of diabetic nephropathy, which is not an uncommon complication of diabetes all over the world. The prevalence of diabetes worldwide has extended epidemic magnitudes and is expected to affect more than 350 million people by the year 2035. There is marked racial/ethnic difference besides international difference in the epidemiology of diabetic nephropathy, which could be attributed to the differences in economic viability and governmental infrastructures. Approximately one-third of diabetic patients showed microalbuminuria after 15 years of disease duration and less than half develop real nephropathy. Diabetic nephropathy is more frequent in African-Americans, Asian-Americans, and Native Americans. Progressive kidney disease is more frequent in Caucasian patients with type 1 than in those with type 2 diabetes mellitus (DM), although its overall prevalence in the diabetic population is higher in patients with type 2 DM because this type of DM is more prevalent. Hyperglycemia is a well-known risk factor for diabetic kidney disease, in addition to other risk factors such as male sex, obesity, hypertension, chronic inflammation, resistance to insulin, hypovitaminosis D, dyslipidemia, and some genetic loci and polymorphisms in specific genes. Diabetic nephropathy is not an uncommon complication of diabetes (type 1 and 2) all over the world and in geriatric population. Management of its modifiable risk factors might help in reducing its incidence in the nearby future.
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Urinary level of vitamin D-binding protein as a new biomarker for diabetic nephropathy
Samy A Khodeir, Nesin M Kotb, Kamal M Okasha, Kamal A Ahmed, Hala M Nagy
January-March 2016, 16(1):32-38
Diabetes is now the major cause of end-stage kidney failure, both in developing and developed nations. It is the primary diagnosis causing kidney diseases in 20-40% of patients starting treatment for end-stage renal diseases worldwide. The aim of the study was to evaluate the urinary level of vitamin D-binding protein (UVDBP) as a new biomarker for diabetic nephropathy (DN). Urine samples were obtained from 45 patients with type 2 diabetes mellitus and were classified into three groups (normoalbuminuric, microalbuminuric, and macroalbuminuric). Fifteen healthy participants served as the control group. The excretion levels of UVDBP were quantified with enzyme-linked immunosorbent assay. The results showed that UVDBP levels were significantly elevated in patients of the DN3 and DN4 groups compared with those of the DN2 group and normal controls. In conclusion, the current study demonstrated that UVDBP levels were significantly elevated in patients with DN. Moreover, a strong positive correlation was observed between the expression level of UVDBP and the development of DN. Thus, the findings indicate that UVDBP levels are a potential biomarker for the early detection of DN.
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PARACRINE ACTION OF MESENCHYMAL STEM CELLS
Vascular endothelial growth factor and insulin growth factor as an underlying paracrine action of mesenchymal stem cells transfused for the regeneration of stage II and III chronic kidney disease
Gamal Saadi, Mervat El Ansary, May A Hassaballa, Mona Roshdy, Eman A El-Aziz, Irene Bishai, Samah Mohamed, Mahmoud El Gaafary, Mahmoud Zidan
January-March 2016, 16(1):3-9
Mesenchymal stem cells (MSCs) are a group of multipotent cells found in cord blood, adipose tissue, bone marrow, and the stroma of various organs with a great potential for mesoderm-like cell differentiation. The aim of the present work was to study the paracrine effect of MSC transfusion in stage II and III chronic kidney disease, which is measured through the level of insulin growth factor-1 and vascular endothelial growth factor. Human bone marrow MSCs were isolated, expanded, and harvested after an average of 21-30 days not only morphologically, when the cells presented as a uniform spindle fibroblast and reached 70-80% confluence with a good cellular yield, but also through their immunophenotypic analysis, which showed positivity for CD29 and negativity for CD34. They were reinjected intravenously in 10 renal patients. To study the effect of such manipulation on the kidney, creatinine and creatinine clearance were measured at the day of injection (baseline), and the first and third month following injection. In addition, other modulators were measured during the first week of injection (day 0, 2, and 7) using enzyme-linked immunosorbent assay. To illustrate, for the first 3 months the creatinine and creatinine clearance reflected a significant renal improvement with an overall decrease of 14% and an increase of 23%, respectively. Although the third month's results may appear worse off than the first month's, they still were better than the baseline before transfusion. Therefore, such an improvement may be attributed to the growth factors released by the MSCs. In other words, both the vascular endothelial growth factor and insulin growth factor-1 showed an overall rise of 3 and 53%, respectively, in their level during the first week after transfusion. Therefore, MSCs transfused to the patients lead to the rise in such modulators, which in turn caused a significant improvement in renal functions. In conclusion, these findings may provide a novel therapy of regenerative medicine especially for chronic kidney disease where dialysis and renal transplantation are inevitable.
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Role of anti-phospholipase A2 receptor antibodies in monitoring of the clinical status in idiopathic membranous nephropathy in Egyptian patients
Rabab Mahmoud Ahmed Mahmoud, Mohammed Gamal El-din Saadi, Tarek Mohammed Fayad, May Abd El-Monem Hassaballa, Khaled Marzouk Sadek, Amr Mohammed Shaker, Mervat Mohammed El-Ansari
October-December 2016, 16(4):119-123
Phospholipase A2 receptor (PLA2R) in the past few years has been identified as an antigenic target in idiopathic membranous nephropathy (IMN). The question remains, however, whether the diagnostic and prognostic values of anti-phospholipase A2 receptor (APLA2R) antibodies apply to patients with IMN who are of different ethnicities. The aim of this research was to assess the prevalence of APLA2R antibodies in Egyptian patients with IMN and to describe the clinical importance of measuring APLA2R antibodies in those patients.
Patients and methods
Using an indirect immunofluorescence (IF) assay, we measured APLA2R antibodies level in 30 patients with IMN in Egypt (three samples/patient). Patients were divided in two groups: group 1 included 15 consecutive patients at the time of diagnosis and group 2 included 15 consecutive patients during their remission or relapse period.
APLA2R antibodies were detected in 40% of the patients in both groups equally. Overall, 68% of them had a nephrotic-range proteinuria (P=0.002). The titer ranged from 1 : 10 to 1 : 40. The reactive patients had significantly lower serum albumin levels at the presentation (P=0.049), and the average time to remission for them was longer in comparison with the nonreactive patients.
In our study, APLA2R antibodies were found in 40% of the patients. It correlates with the disease activity regarding remission and relapse, and its reactivity was higher in more severe disease.
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Effect of Ramadan fasting on patients with different kidney diseases: An updated review
Yasser ELSayed Matter, Hussein A Sheashaa, Ayman F Refaie
January-March 2018, 18(1):1-5
Ramadan fasting is one of the five pillars of Islam and is compulsory for all adult Muslims who have no medical or religious excuses. Ramadan fasting is defined as a complete abstinence from food, drink, medications, sexual activity, and smoking from dawn to dusk. Regarding the kind Islamic religion, patients have permission not to fast according to the medical advice. However, most Muslim patients express their desire to fast during Ramadan month and they are very broken when their physicians inform them not to fast. There are a lot of controversies regarding Ramadan fasting for chronic kidney diseases (CKD) and hemodialysis patients with absence of strict guidelines that help nephrologists in this issue. Renal transplant recipients who have stable kidney function for at least 1 year post-transplantation can fast with cautious follow-up. Risk of dehydration due to fasting for long periods especially in the summer season is the main concern for patients with kidney stone diseases. There is still no strong evidence if that Ramadan fasting can induce renal stone formation in susceptible patients or not. However, most studies have shown that fasting for this kind of patients with good hydration after breaking the fast may be allowed without significant risk of renal colic incidence. According to the last published guidelines by the International Diabetes Federation and Diabetes and Ramadan International Alliance, Chronic dialysis or CKD stages 4 and 5 and CKD stage 3 patients are considered to be at very high risk and high risk categories, respectively, and are exempted from fasting.
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