Nephrology and Transplantation

Plasminogen activator inhibitor-1 gene polymorphisms in systemic lupus erythematosus: is there a risk for lupus nephritis among Egyptians? Ahmed A Eldeeb, Alaa Sabry, Elshahat A Yousef, Rasha Mahmoud, Ahmed B Ibrahim, Wael Alkhiary Journal of The Egyptian Society of Nephrology and Transplantation 2019 19(1):1-7 Background Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by immune complexes formation and body organs damage. Recently, plasminogen activator inhibitor-1 (PAI-1) has been proposed recently to modulate the immune response. Aim of the study To elucidate whether there is possible role of two genetic polymorphisms in the PAI-1 gene: −675 4G/5G and HindIII C>G in lupus nephritis (LN) disease in Egyptian patients. Patients and methods Using PCR-restriction fragment length polymorphism, we genotyped 170 Egyptian patients with SLE; 80 fulfill the American College of Rheumatology criteria of LN and 90 SLE patients without LN for two polymorphisms of PAI-1 gene: −675 4G/5G and HindIII C>G. Results The 4G4G genotype, 4G allele of PAI 4G/5G polymorphism, and the G allele of the PAI-1 HindIII C>G polymorphism, all exhibited significant risks for proliferative LN [odds ratio (OR)=2.55; 95% confidence interval (CI): 1.02–21.11; P=0.022); (OR=2.43; 95% CI: 1.18–5.01; P=0.015); (OR=2.37; 95% CI: 1.01–5.58; P=0.045), respectively]. Moreover, PAI-1 4G/5G polymorphism was related to the chronicity index for LN (P<0.001), while PAI-1 HindIII C>G polymorphism was associated with the activity (P=0.016) and the chronicity (P<0.001) indices of LN in SLE patients. Conclusion Egyptian patients with SLE with a polymorphism for −675 4G/5G and HindIII C>G of PAI-1 gene might have a higher susceptibility for the development of proliferative LN.

Analysis of different treatments and their outcomes in idiopathic membranous nephropathy: a single-center observational study Avinash Rao, Abhijit Konnur, Umapati Hegde, Milind Dakate Journal of The Egyptian Society of Nephrology and Transplantation 2019 19(1):8-12 Background Although there are multiple treatment modalities for idiopathic membranous nephropathy (IMN) which have been studied in different streams of populations, there is no single convincing answer for the best accepted modality. In the study presented, we have made an effort to compare the different treatment regimens and analyze the results obtained. Patients and methods This was a retrospective observational study. A total number of 54 patients with idiopathic membranous nephropathy were included in the study. Five different treatment groups were made, which included modified Ponticelli regime, oral cyclophosphamide, oral mycophenolate mofetil, oral tacrolimus, and intravenous rituximab therapy, and were followed up for 1 year. Urine protein to creatinine ratio, serum albumin, creatinine, and estimated glomerular filtration rate were noted at 1, 3, 6, 9, and 12 months. Results Among the 54 patients, 10 of 16 patients in modified Ponticelli group, 9 of 18 in oral cyclophosphamide group, 4 of 9 in oral mycophenolate mofetil group, 3 of 6 in oral tacrolimus group, and 3 of 5 in intravenous rituximab group achieved remission. There was statistically significant improvement in renal function in modified Ponticelli group (P=0.02) and oral cyclophosphamide group (P=0.01) as compared with the other groups. Conclusion Patients who received modified Ponticelli regime had superior outcomes in terms of improvement in renal function and renal survival as compared with other different therapies. Large studies with long-term follow ups are needed to support the outcome.

Serum hepcidin levels and erythropoietin resistance in hemodialysis patients Walid M Afifi, Ezzat Mostafa, Mohamed Elsaid, Ghada Elakad, Huda F Ebian Journal of The Egyptian Society of Nephrology and Transplantation 2019 19(1):13-18 Introduction Erythropoietin (EPO) resistance is an important cause of anemia in patients with chronic kidney disease. Enhancement of erythropoiesis by EPO requires intact EPO signaling and effective mobilization of iron stores. Enhanced synthesis of hepcidin leads to reduction of iron absorption in the small intestine and sequestering of iron in macrophages. Hepcidin may contribute to EPO resistance through a direct inhibitory effect on erythroid progenitor proliferation and survival. Objective To assess serum hepcidin levels in patients undergoing hemodialysis (HD) treatment and to distinguish its analogous association with anemia parameters and EPO resistance. Patients and methods A cross-sectional study was carried out among HD patients at Nephrology Unit of the Zagazig University Hospital from 2017 to 2018. The study included 90 participants, meeting our inclusion criteria, who had end stage renal disease (ESRD) and were on regular HD three times weekly. All patients were subjected to full history taking and clinical and laboratory assessment. It included routine investigations, with complete blood picture, calcium, phosphorus, parathyroid hormone (PTH), lipid profile, iron panel, and c reactive peptide (CRP). Specific investigations included the EPO resistance index and serum hepcidin measurement. Results Hepcidin is positively related to EPO resistance index. EPO resistance index as well as ferritin were significant determinants of hepcidin in HD patients. Conclusion Hepcidin is associated with anemia, iron status, and microinflammation in HD patients. If used as a diagnostic tool, it might improve iron therapy during periods of reticuloendothelial blockage of iron transport. This is important to avoid iron overload and to improve EPO response in patients with ESRD.

Regulatory T-cells dysregulation in type 2 diabetic nephropathy Walaa H.M Ibrahim, Mostafa G Aly, Ahmad B Ahmad, Noha G Sayed, Heba S Galal, Muhammad H Al-Maghraby Journal of The Egyptian Society of Nephrology and Transplantation 2019 19(1):19-23 Background An immune-mediated process has been postulated to be involved in the pathogenesis of diabetic nephropathy (DN). Regulatory T-cells (Tregs) mediate self-tolerance and allogeneic tolerance and alteration in its expression was supposed to mediate the development of type 2 DN. We are interested in studying the expression of Treg cells in type 2 DN patients. Patients and methods We conducted a cross-sectional study carried out on 25 type 2 DN patients and 23 nondiabetic control patients. Demographic data were recorded in predefined data sheets. Blood samples for laboratory variables were collected and measured using the standard methods. Flow cytometry analysis was used to assess the phenotype and function of Treg cells from blood samples. Results In the current study, DN patients had a statistically significant higher Treg expression (P=0.038). There were insignificant associations between Treg cells and both proteinuria and duration of diabetes mellitus (P>0.05). Although univariate analysis showed that absolute Treg cell count and duration of diabetes were independent predictors of estimated glomerular filtration rate (P=0.028, 0.039, respectively), multivariate analysis showed that only the absolute Treg cell count was an independent predictor of estimated glomerular filtration rate with a just borderline statistical significance (P=0.048). Conclusion The current study did not support the immunological base of DN and we recommend testing the expression of other T-cell subtypes and cytokines in type 2 DN patients to be more confident about this thinking.

Practical approach to urine leak after kidney transplant Ravi Mohanka, Lokesh Sinha, Jitendra Jagtap, Ajay Sharma, Ahmed Halawa Journal of The Egyptian Society of Nephrology and Transplantation 2019 19(1):24-29 Urological complications can cause significant morbidity after kidney transplant but can be prevented by following well-known good surgical principles and techniques. The key is early identification and appropriate intervention. This article discusses clinical presentation, investigations, and principles of management of a urine leak after kidney transplant on the background of a clinical case. The presence of a ureteric catheter, double J ureteric anastomotic stent, vascularity of transplanted ureter, and bladder capacity is critical for differential diagnosis, choice of investigation, and management of ureteral leak. The given case demonstrates an early extraperitoneal high-volume urinary leak. Additional information about the surgery, graft quality, and postoperative clinical course may help in differential diagnosis. Drain fluid creatinine and potassium analysis compared with serum can confirm the leak, whereas radiological imaging can localize it. Depending on the cause and site of leak identified, a conservative management approach using maximal decompression or surgical repair or reconstruction may be appropriate.