Abstract Background Acute kidney injury (AKI) constitutes a severe and potentially fatal complication frequently encountered in patients exhibiting profound physiological derangement. It aimed to determine the incidence of AKI, delineate the principal predisposing risk factors, and evaluate its impact on clinical outcomes in intensive care unit (ICU) patients. Methods 200 critically ill patients enrolled and divided into two groups: AKI group (n = 122) and non-AKI group (n = 78). Data collection encompassed socioeconomic and clinical characteristics, laboratory findings, and validated severity-of-illness scoring systems, namely Acute Physiology and Chronic Health Evaluation (APACHE) and Sequential Organ Failure Assessment (SOFA) scores. Results AKI occurred in 61% of study population. Significant comorbidities associated with its development included hypertension, diabetes mellitus, and pre-existing chronic kidney disease (P < 0.05). Multivariate logistic regression analysis identified independent predictors of AKI: advancing age [OR 1.0074 (95% CI 1.0020–1.0128)], lower Glasgow Coma Scale score [OR 0.6106 (95% CI 0.5210–0.7155)], higher APACHE score [OR 1.0346 (95% CI 1.0129–1.0569)], and elevated SOFA score [OR 1.0285 (95% CI 1.0043–1.0533)]. Patients experiencing AKI exhibited substantially prolonged hospital stays (mean 9.52 ± 6.39 days) and ICU durations (mean 8.52 ± 5.96 days) relative to the non-AKI cohort. Recovery was observed in 52 AKI patients (42.62%), whereas mortality reached 46.72% in AKI group, markedly exceeding the 12.82% rate in non-AKI patients (P < 0.001). Conclusion In critically ill populations, AKI is strongly associated with extended hospital and ICU lengths of stay as well as substantially heightened mortality risk.

To explore the role of vinculin in the development of glomerulonephritis Q2R2. Vinculin is well-known for its specific role in stabilizing the adhesion between cells and the extracellular matrix (ECM), which regulates the strength of this adhesion in turn. A cross-sectional study was conducted involving 72 participants, who were categorized into two groups: 36 participants diagnosed with glomerulonephritis and 36 healthy participants as a control group. An enzyme-linked immunosorbent assay (ELISA) was used to analyze the serum vinculin levels in both groups. Compared to healthy controls, serum vinculin concentration in patients with glomerulonephritis was much higher (2246.7 ± 902.6 vs. 205.2 ± 191.2 P < 0.001) with a positive correlation between vinculin levels in blood and urinary protein/creatinine ratio (p < 0.05). In the case of glomerulonephritis, serum vinculin levels were, however, not found to be associated with any of the glomerulonephritis clinicopathological features. Vinculin levels are significantly higher in blood serum in patients with glomerulonephritis and positively correlated with the progression of proteinuria. This poses a salient possibility for the role of vinculin in the development of glomerulonephritis. Further research into the molecular processes by which this protein may influence the development of glomerulonephritis might lead to improved clinical treatments and the development of new molecular therapeutics.

Background Sarcopenia is prevalent among hemodialysis patients and is linked with decreased physical function, diminished quality of life, and a total increase of cardiovascular risk. Patients and methods A cross-sectional study was conducted at Menoufia University Hospitals, including 86 end-stage renal disease patients, who were classified into three groups according to the European Working Group on Sarcopenia in Older People 2 criteria based on sarcopenia severity. Medical history, anthropometric measurements, nutritional condition, physical function tests, and laboratory investigations were included to analyze differences between groups, considering influential factors. Results Sarcopenia’s bioimpedance parameters including appendicular skeletal muscle index (16.21 ± 2.40), appendicular skeletal muscle index (5.02 ± 1.19), phase angle (°) (5.7 ± 0.5) hand strength (20.81 ± 5.15), were significantly lower than the nonsarcopenic group with low physical activity assessed by International Physical Activity. The multivariate analysis and the receiving operation characters curve revealed that malnutrition was the most predicted risk factor for sarcopenia in regular hemodialysis patients (odds ratio=3.54; confidence interval: 1.911–5.814, P =0.000) with cut off value less than 3.5 with high sensitivity and specificity followed by diabetes mellitus (odds ratio=1.619; confidence interval: 0.312–0.852, P =0.01) and other predictors. Conclusion Malnutrition, physical inactivity, and associated comorbidity may be significant modifiable factors in the sarcopenia development and progression in hemodialysis cases. These results emphasize the value of early screening and individualized intervention strategies for managing sarcopenia in affected patients.

Background Frailty is associated with aging, but it is more prominent among the patients on dialysis and characterized by increased vulnerability to stressors, which is associated with adverse outcomes and poor quality of life. The aim of this study is to evaluate the association of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and frailty in hemodialysis patients and the effect on their outcomes. Patients and methods A cross-sectional study was conducted on 80 patients, divided into two groups according to their Till Burg Frailty indicator. Sociodemographic data, laboratory investigations, assessment of dialysis adequacy, anthropometric measures, calculation of NLR and PLR, and Tilburg Frailty Indicator were assessed in all participating patients. Outcomes included hospitalization, physician visits, disability, and mortality were evaluated. Results The Tilburg Frailty Instrument correlates positively with age, duration of dialysis, and inflammatory markers NLR and PLR and negatively with mean arm circumference, hemoglobin, serum phosphorus, and high-density lipoprotein. The linear regression revealed that the frailty would be increased ( B =0.041, 0.015, and 0.010) as the duration of dialysis, PLR, and NLR increased, respectively. Furthermore, the frailty will be raised ( B =−0.48) as the phosphorus serum level declines. The optimal cut-off value of NLR was more than 1.64, and of PLR was more than 96.88 to predict frailty in end-stage renal disease patients. Frequent physician visits and hospitalization were prevalent in frail patients with no effect on disability and mortality of the studied patients. Conclusion The PLR and NLR have a diagnostic value of frailty and are associated with increasing the prevalence of frequent physician visits and hospitalization among frail hemodialysis patients.

Background NAFLD is a spectrum of disorders ranging from hepatic steatosis to nonalcoholic steatohepatitis (NASH), NASH related cirrhosis and hepatocellular carcinoma (HCC). There is sparse data on the prevalence CKD in Egyptian patients with NAFLD. The aim of this study is to estimate the prevalence of CKD in the subjects with NAFLD and to assess the risk factors of CKD among them. Methods A cross-sectional study was conducted on 430 patients from the Internal Medicine Department, Menoufia University Hospitals, including 215 patients with NAFLD, and 215 patients without NAFLD. NAFLD was diagnosed by abdominal ultrasonography. The liver fibrosis was assessed by NAFLD fibrosis score (NFS) and fibrosis-4 index (FIB-4). CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 and/or abnormal albuminuria (urinary albumin-to-creatinine ratio ⩾ 30 mg/gm). The logistic regression analysis was performed to examine the association between NAFLD and risk of CKD. Results The prevalence of CKD was higher in individuals with NAFLD than in those without NAFLD (38.1% vs 7.4%, p < 0.001). Logistic regression analysis demonstrated that both NAFLD and CKD were risk factors of each other. The presence of hypertension, high levels of BMI and waist circumference were the other independent risk factors of NAFLD. While the presence of DM, and the high level of BMI were the other significant risk factors of CKD in the NAFLD group. Conclusion The presence and severity of NAFLD are associated with an increased risk of CKD.

Intradialytic hypertension (IDH) is an important emerging complication in hemodialysis patients. No study has examined the diagnostic markers of various risk factors for the occurrence of IDH in chronic hemodialysis patients. Therefore, our study aimed to assess the use of nitric oxide (NO) as a marker of IDH among end-stage renal disease patients. The patients were divided into two groups: Group I (40 patients) with IDH and Group II (40 patients) without IDH. For all participants, a full medical history was taken, followed by laboratory examinations to measure the level of NO and a clinical examination. The dose of erythropoietin per week, the level of intact parathyroid hormone, and platelet count were significantly higher in Group I than in Group II, whereas the mean level of NO (2.10 ± 1.23 pmol/L) was highly significantly lower in patients with IDH (P < 0.001). Multivariate analysis showed that hypertension (odds ratio: 1.824, 95% confidence interval: 1.273-2.982) and the level of NO (odds ratio: 1.68, 95% confidence interval: 1.13-2.97) were independent risk factors for IDH. The receiver operating characteristic curve showed that the cutoff point of NO was 2.52 μmol/L to differentiate between cases with and without IDH (area under the curve = 0.844). Our findings support previous research regarding the involvement of endothelial dysfunction and a higher sodium level in the pathogenesis of IDH. We also found that the NO level had a good diagnostic value for the occurrence of IDH at a cutoff of 2.52 μmol/L.

Long non-coding RNA (lncRNA) TUG1 acts as a proto-oncogene, allowing the proliferation of tumor cells, and it has been related to inflammation. Therefore, we aimed in this study to investigate for the first time the role of TUG1 gene polymorphism and the TUG1 level as biomarkers in systemic lupus erythematosus (SLE) and their link to lupus nephritis 145 SLE. A total of 145 healthy controls were subjected to clinical and laboratory evaluation. The disease activity was assessed by the SLE disease activity index (SLEDAI) score. SLE patients were divided into two subgroups according to the presence of lupus nephritis. The TUG1 gene polymorphisms rs5749201 and rs886471 were determined by Sanger sequencing, and TUG1 expression was assessed by qRT-PCR. There was a significant increase in the risk of SLE AA, TA, dominant genotypes, and the A allele of rs5749201 (p < 0.001) by 4.9-, 10.1-, 6.5-, and 2.5-fold in comparison to the relative control. GG and TG, dominant genotypes and the G allele of rs886471 (p < 0.01) increased the risk by 5.09-, 11.9-, 6.5-, and 2.6-fold. AA, A allele, dominant and recessive rs5749201genotypes increased the risk of lupus nephritis by 16.6-, 7.4-, 7.1-, and 12.2-fold, respectively (p < 0.05). GG, dominant and recessive genotypes, and the G allele of rs886471 increased the risk of lupus nephritis by 17.04-, 7.8-, 9.4-, and 6.08-fold, respectively (p < 0.05). Additionally, the AG haplotype increased the risk of SLE and lupus nephritis by 2.7- and 7.8-fold, respectively. The AA rs5749201 and GG rs886471 variants are significantly associated with more severe disease (p < 0.001). TUG1 expression was significantly higher in SLE than in the control and in the lupus nephritis than in non-lupus nephritis cases (p < 0.05). Interestingly, AA rs5749201 and GG rs886471 were significantly associated with higher TUG1 levels (p < 0.001). It was also found that AA rs5749201 and high SLEDAI were predictors of lupus nephritis. Overall, our findings illustrated for the first time that TUG1 gene rs5749201 and rs886471 variants were associated with increased risk of SLE, more severe disease, and lupus nephritis, and the TUG1 level could be used as a diagnostic biomarker of SLE and lupus nephritis.

Background: Diabetic nephropathy (DN) is one of the most frequent complications in approximately one third of diabetic patients, and it is still a matter of controversy. Sirtuin1 and Insulin receptor (INR) gene have been integrated in the pathogenesis of metabolic diseases including type 2 diabetes mellitus and diabetic nephropathy. Objective: Our objective is to assess INR gene rs2252673 and Sirtuin1 rs7069102 SNPs as risk factors for DN in the Middle East. Methods: 280 individuals, divided into 90 patients with DN (group I), 90 patients with type II diabetes mellitus (group II), and 100 age- and gender-matched healthy subjects as the control group (group III) underwent laboratory investigations including the detection of (INR) gene rs 2,252,673 and Sirtuin1 rs7069102 SNPs using PCR real-time technique. Results: Regarding genotype frequency and allelic distribution of Sirtuin1 rs (7069102), a significant statistical increase of CC genotype and C allele was observed in Group I compared to that in Groups II and III. Our results revealed that the existence of CC genotype and C allele increases the risk for developing DN (OR: 2.64 and 95% CI: 1.21-5.74; 1.80 and 1.18-2.73, respectively). Conclusion: Our findings propose that the polymorphisms of SIRT1 play a role in the susceptibility of T2DM and the development of DN, but insulin receptor gene rs2252673 polymorphism had no role in the development of T2DM or DN. Finally, SIRT1 rs7069102 but not insulin receptor gene rs2252673 could be used as a marker for susceptibility to DN in T2DM patients, so The SIRT1 pathway is a new therapeutic target for DN.

Background: SARS-CoV-2 has a number of targets, including the kidneys. Acute Kidney Injury (AKI) might develop in up to a quarter of SARS-CoV-2 patients. In the clinical environment, AKI is linked to a high rate of death and leads to the progression of AKI to chronic renal disease. Aim: We aimed to investigate rs2093266 and rs1955656 polymorphisms in SERPINA4 and SERPINA5 genes, respectively, as risk factors for COVID-19 induced AKI. Subjects and methods: A case-control study included 227 participants who were divided into three groups: 81 healthy volunteers who served as controls, 76 COVID-19 patients without AKI and 70 COVID -19 patients with AKI. The TaqMan assay was used for genotyping the SERPINA4 (rs2093266) and SERPINA5 (rs1955656) polymorphisms by real-time PCR technique. Results: Lymphocytes and eGFR showed a significantly decreasing trend across the three studied groups, while CRP, d-Dimer, ferritin, creatinine, KIM-1and NGAL showed a significantly increasing trend across the three studied groups (P < 0.001). Rs2093266 (AG and AA) genotypes were significant risk factors among non-AKI and AKI groups in comparison to controls. Rs1955656 (AG and AA) were significant risk factors among the AKI group, while AA was the only significant risk factor among the non-AKI group. Recessive, dominant, codominant, and over-dominant models for genotype combinations were demonstrated. The GG v AA, GG + AG v AA, and GG v AG + AA models of the rs2093266 were all significant predictors of AKI, whilst only the GG v AA model of the rs1955656 SNP was a significant predictor. The logistic regression model was statistically significant, chi(2) = 56.48, p < 0.001. AKI was associated with progressed age (OR = 0.95, 95% CI: 0.91-0.98, p = 0.006), suffering from chronic diseases (OR = 3.25, 95% CI: 1.31-8.01, p = 0.010), increased BMI (OR = 0.89, 95% CI: 0.81-0.98, p = 0.018), immunosuppressive (OR = 4.61, 95% CI: 1.24-17.16, p = 0.022) and rs2093266 (AG + AA) (OR = 3.0, 95% CI: 1.11-8.10, p = 0.030). Conclusion: Single nucleotide polymorphisms (rs2093266) at SERPINA4 gene and (rs1955656) at SERPINA5 gene were strongly linked to the development of AKI in COVID-19 patients.

Objective The aim of this study was to evaluate the possible role of mast cell tryptase (MCT) enzyme in the pathogenesis of uremic pruritus by measuring its level in the serum of patients with chronic kidney disease (CKD) with pruritus and to correlate its level with the severity of pruritus. Background The pathogenesis of pruritus in renal disease is not yet understood. Evidence suggests that mast cells play a role, as the number of dermal mast cells is increased in patients on hemodialysis. Patients and methods The present study was conducted as a prospective case–control study that included 60 patients with CKD and 20 healthy participants who had neither CKD nor pruritus and served as controls. All cases were selected from the Outpatient Clinic and Dialysis Unit of Nephrology Department, Menoufia University Hospitals, and Aga General Hospital, spanning the period from February 2017 to July 2017. Patients with CKD were subdivided into three groups according to the stage of kidney disease as follows: group 1 included 20 patients with stage 3 (CKD), group 2 included 20 patients with stage 4 (CKD), group 3 included 20 patients with stage 5 (CKD), known as end-stage renal disease, who were on hemodialysis. Each participant underwent full general and dermatologic examination followed by measurement of serum MCT enzyme by enzyme-linked immunosorbent assay. Degree of pruritus was measured by 5D score. Results Serum MCT levels were above 11.4 ng/ml (95th percentile) in patients with CKD. The intensity of pruritus correlated significantly (P = 0.001) with the tryptase levels. Conclusion Mast cells or even tryptase itself may be involved in the pathogenesis of pruritus in patients with CKD.

Background It has been demonstrated that acute rejection (AR) episodes are major risk factors of renal allograft loss. Still the impact of early acute rejection (EAR) on long-term graft survival is debated. The aim of this study was to study the impact of early acute rejection (EAR) and late acute rejection (LAR) on renal allograft survival. Patients and methods In this retrospective study we investigated the timing and frequency of AR episodes in 120 kidney transplant recipients for a 3-years period. Patients were divided into three groups; Group I: No acute rejection (No-AR), Group II: Early acute rejection (EAR), and Group III: Late acute rejection (LAR). The graft survivals in the three groups and the associated risk factors were analyzed. Results Of the 120 recipients one patient died (0.08%) and 14 grafts were lost (11.6%). The graft survival durations were 35.2, 23.6 and 27.2 months and the 3-years survival rates were 93%, 63.3% and 66.7% in the three groups respectively. The graft survival durations and rates were significantly higher in group I compared to groups II and III with no significant differences between the last two groups. Conclusion Both EAR and LAR have deleterious effects on graft survival following kidney transplantation.

Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic condition with various genetics and environmental influences that affects the capacity of the body to produce or use insulin resulting in hyperglycemia, which may lead to variable complications. It is one of the world’s rising health problems. There is emerging evidence that some genetic polymorphisms can impact the risk of evolving T2DM. We try to determine the relationship of (rs7903146) variant of the Transcription factor 7-like 2 (TCF7L2) gene with T2DM and its microvascular complications. This case–control study included 180 subjects: 60 diabetic patients without complications, 60 diabetic patients with microvascular complications and 60 matched healthy controls. Genotypes of rs7903146 (C/T) SNP in the TCF7L2 gene were evaluated by real-time polymerase chain reaction via TaqMan allelic discrimination. Logistic regression was used to detect the most independent factor for development of diabetes and diabetic microvascular complications. Variant homozygous TT and heterozygous CT genotypes were significantly increased in diabetic without complications and diabetic with complications groups than controls (p = 0.003, 0.001) respectively. The T allele was more represented in both patient groups than controls with no significant difference between patient groups. TT genotype as well as T allele was significantly associated with increased T2DM risk. The T allele of rs7903146 polymorphism of TCF7L2 confers susceptibility to development of T2DM. However, no significant association was found for diabetic complications.

ObjectiveThe aim was to study the effect of increased mean platelet volume/platelet count (MPV/PL count) on arteriovenous fistula (AVF) function in chronic hemodialysis (HD) patients.BackgroundVascular access failure substantially contributes to morbidity and hospitalization in HD patients.Patients and methodsA case–control study was conducted on 50 HD patients on regular HD for more than 6 months in Shebin El-Koom Teaching Hospital, Menoufia, Egypt. The patients were divided into two groups: 25 patients with functioning AVF as group 1 and 25 patients with nonfunctioning AVF as group 2. Patients were subjected to full history taking, clinical examination, laboratory workup, and radiology by Duplex ultrasound.ResultsThere was no significant effect of age, sex, BMI, diabetes mellitus, hypertension, smoking, or type of anastomosis on AVF in HD patients. There was a significant effect of intradialysis hypotension on AVF in HD patients. There was a highly significant effect of fistula function on Kt/V in HD patients. There was a highly significant increase of MPV/PL count ratio in HD patients with failure of AVF. MPV/PL count at a cut-off level of 53.7 can accurately predict failure of AVF in the studied HD patients with 100% sensitivity and 84% specificity.ConclusionAssessment of MPV/PC ratio could adequately predict the failure of the function of AVF in the studied patients.

Background Early detection of vascular access complication prevents more severe conditions and reduces hospitalization periods of patients on regular hemodialysis (HD). Access recirculation (AR) is one of the tools for early evaluation of arteriovenous fistula (AVF) complication for early intervention. The aim of our study was to evaluate the AV AR as a risk factor for inadequate HD in patients with end-stage renal disease in Menoufia university hospitals. Patients and methods This is a cross-sectional study that included 300 patients on regular HD sessions at four centers at Menoufia university hospitals. All patients were subjected to detailed history taking, clinical examination, laboratory investigation, and measurement of recirculation by urea-based method. Results This study included 300 patients on regular HD. It showed that 51.7% presented with aneurysm, whereas the infected AV access was presented in 6% of patients. AR was found in 17.7% of patients, being more frequent in patients with the left brachiocephalic AVF (37.7%), and it showed highly significant relation with duration of dialysis and duration of AVF creation. The risk factors for recirculation were the distance between arterial and venous needle sites, puncture site aneurysm, and stenosis. There were negative correlations between AR and both urea reduction ratio and KT/V and positive with both serum potassium and parathyroid hormone level. Conclusion AR in our unit was associated mainly with stenosis, aneurysm, and improper needle puncture sites, so screening for recirculation may be used as a surveillance technique for the early detection of AVF in concomitant with regular training of dialysis staff in cannulation of the AVF.

Objective This study aimed to investigate the relationship between vitamin D levels and health-related quality of life in maintenance hemodialysis patients. Background Several conditions associated with vitamin D deficiency in end-stage renal disease and hemodialysis patients can indirectly or directly affect the quality of life. Patients and methods The present study included 85 end-stage renal disease patients, subdivided into group I, which included 64 vitamin D-deficient patients, and group II, which included 21 vitamin (D)-efficient patients. Every participant was subjected to sociodemographic, clinical, and laboratory evaluations; each patient underwent a full general assessment of health-related quality of life by the Arabic version of the kidney disease quality of life short-form 1.3” questionnaire and measurement of serum 25(OH)D by an enzyme-linked immunosorbent assay. Results The mean 25(OH)D levels were 15.7 ± 6.40 and 36.6 ± 5.99 ng/ml for the vitamin D-deficient group and -efficient group, respectively. The only factor independently associated with symptoms was serum 25(OH)D level (P = 0.044). Sex (female) and vitamin D levels were independent risk factors with the effect of kidney disease (P = 0.001). Independent risk factors associated with the burden of kidney disease subscale were comorbidity index and serum 25(OH)D levels (P = 0.015, 0.023, and 0.001, respectively). Serum 25(OH)D and age were independently associated with the physical component summary (P = 0.001 and 0.016). The independently associated factor with the mental component summary was serum 25(OH)D and albumin levels (P = 0.001 and 0.016). Conclusion Lower serum vitamin D levels were negatively associated with all subscales of quality of life in maintenance hemodialysis patients.

Background: Chronic kidney disease (CKD) is a worldwide public health alarming problem. Although both heart and kidneys are separated by a quite distance within the body and they perform varied functions, there is a close physiological relationship between them. The diseases in the kidneys can trigger a disease in the heart and vice versa. High blood pressure is the most significant risk factor for the development and progression of chronic kidney disease (CKD). Lowering blood pressure is a goal to prevent CKD progress. Chronic abnormalities in cardiac function (e.g., chronic congestive heart failure) causing, chronic kidney disease and anemia appear to act together in a vicious circle in which each condition causes or exacerbates the other progressive chronic kidney disease. Objective: To assess the prevalence of chronic kidney disease in patients with cardiovascular disease at Shebin El-Kom Teaching Hospital and Menoufia University Hospital Cardiology Outpatient Clinic, Menoufia Governorate, Egypt. Methods: This is a cross-sectional study that was conducted in Shebin El-Kom Teaching Hospital Cardiology Outpatient Clinic, Menoufia University Cardiology Outpatient Clinic from April 2019 to July 2019. This study included 200 patients with cardiovascular disease or hypertension for more than 6 months. All patients were subjected to detailed history taking, clinical examination, laboratory investigation, echo and abdominal ultrasound. Results: This study included 200 patients with cardiovascular disease or hypertension for more than 6 months, which showed that: 63 (31.5%) were diagnosed as chronic kidney disease, 24 (38%) known to be CKD, 39 (62%) not known diagnosed in our study. Uncontrolled hypertension, congestive heart failure, diuretics and ACEI or ARBS with diuretics together are significant risk factors for renal impairment; uncontrolled hypertension and diuretics are the most predictors for renal impairment. Conclusion: Uncontrolled hypertension is the most preventable cause of renal impairment; RAAS not cause renal impairment but lead to decreased GFR in CKD patients. We should be careful with ACEI or ARBS with diuretics or diuretics only and control congestive heart disease to avoid kidney injury and chronic cardiorenal.

BACKGROUND:Increasing interest has been focused on lncRNAs as potential markers in the pathogenesis and progression of numerous diseases.AIM:We aimed to investigate the expression pattern and role of cell-free lncRNAs (GAS5, HCG27_201 and LY86-AS1) in pre-diabetic, diabetic and T2DM groups.SUBJECTS & METHODS:Quantification of the expression level of cell-free lncRNAs (GAS5, HCG27_201 and LY86-AS1) was performed by real-time PCR in 210 individuals classified in diabetic (T2DM), pre-diabetic and control groups.RESULTS:Significant differences were observed in the relative expression level of lncRNAs (GAS5, LY86-AS1 and HCG27_201) among the three studied groups. The LncRNA expression levels decreased gradually from the control to the pre-diabetic group and reached the lowest values in the T2DM group. The A receiver operating characteristic curve (ROC) was applied to identify a cut-off value for each of the three genes among our groups. The three lncRNAs showed promising results in discriminating between the diabetic patients and controls, with HCG27_201 gene expression having the best performance. Furthermore, lncRNA expression was able to predict the future development of DM in the pre-diabetics because ROC analysis among diabetics and pre-diabetics revealed considerable results. GAS5 gene expression showed the best performance. Additionally, HCG27_201 expression was the most valuable biomarker for differentiating between pre-diabetics and controls and presented a sensitivity of 91% and specificity of 64%.CONCLUSIONS:We concluded that cell free lncRNAs (GAS5, LY86-AS1 and HCG27_201) could be considered promising diagnostic and predictive biomarkers for DM and that HCG27_201 could act as a potential diagnostic biomarker for pre-diabetes.

Objective The aim was to study the value of dialysis sodium gradient as a modifiable risk factor for fluid overload in hemodialysis patients. Background It is important to minimize sodium gradient in hemodialysis patients, as it positively correlates with changes in blood pressure during hemodialysis and intradialytic weight gain (IDWG). Patients and methods A cross-sectional analytical study was done on a group of 102 hemodialysis patients divided into three groups: group I included 56 patients with no blood pressure variability, group II included 24 patients who had intradialytic hypotension, and group III included 22 patients who had intradialytic hypertension. All patients attended the Hemodialysis Unit, Zefta General Hospital, Al-Gharbia Governorate, Egypt, during the period from May 2018 to November 2018. Complete history, hemoglobin level, predialysis and postdialysis urea and creatinine, and predialysis sodium were tested. Results There were no statistically significant differences between the studied groups regarding sex (P = 0.1939), age (P = 0.192), primary renal diseases (P = 0.189), vascular access type (P = 0.978), dialysis duration (0.976), hemoglobin (P = 0.131), predialytic and postdialytic urea (P = 0.839, P = 0.120), predialytic and postdialytic creatinine (P = 0.584, P = 0.190), ultrafiltration (UF) rate (P = 0.729), UF volume (P = 0.698), IDWG% (P = 0.777), and sodium gradient (P = 0.468). There was a positive correlation between sodium gradient and the mean IDWG%, mean UF volume, and mean UF rate among the studied hemodialysis patients. Conclusion There was a positive correlation between sodium gradient and IDWG and consequently UF volume and UF rate.

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder; lupus nephritis (LN) is the main cause of disability and death in SLE patients. Although long noncoding RNAs (lncRNAs) lack a protein-coding ability, they have a significant role in the regulation of gene expression. We aimed to evaluate cell-free lncRNAs (NEAT2, CTC-471 J1.2 and Inc-DC) as biomarkers for SLE and LN. Quantification of the expression level of cell-free lncRNAs (NEAT2, CTC-471J1.2 and lnc-DC) was performed by real-time PCR in 90 controls and 139 patients with SLE, who were further subdivided into 70 patients with LN and 69 patients without LN. The expression levels of the NEAT2 and Inc-DC genes were significantly up-regulated and that of the CTC-471J1.2 gene was down-regulated in patients with SLE versus controls. Additionally, NEAT2 showed the best performance to differentiate SLE patients from controls, with a sensitivity of 92% and a specificity of 89%. To predict the future development of LN, CTC-471J1.2 showed the highest sensitivity (87%) and specificity (90%). A significantly positive correlation was found between Inc-DC expression and the activity of SLE (as assessed by the SLEDAI score) in LN patients, and a negative correlation was found between CTC471J1.1 expression and the SLEDAI score in both SLE subgroups. We concluded that cell-free NEAT2 is the most sensitive biomarker for SLE diagnosis and that circulating CTC-471J1.2 is the most specific and sensitive diagnostic biomarker for LN. Both lnc-DC and CTC-471J1.2 could be considered predictive biomarkers for SLE activity and LN development.

Background Insulin resistance (IR) is a characteristic feature of uremia. Both IR and metabolic syndrome are considered independent predictors for cardiovascular events and mortality in patients with chronic kidney disease. Few studies have shown a favorable effect of erythropoietin (EPO) in decreasing IR. We hypothesized that short-term treatment with EPO can lead to improvement of IR in patients with chronic kidney disease. Patients and methods Patients were categorized into two groups: 20 hemodialysis patients (HDP) not receiving EPO (control) compared with other 40 HDP divided into two subgroups (20 diabetics and 20 nondiabetic), both receiving EPO (intervention group) all over the duration of the study, which extended for 6 months. All patients were subjected to history taking, full clinical examination, as well as laboratory investigations. Results All baseline results of parameters of glycemic control showed significant stepwise increase from nondiabetic intervention group, to control group, and then to diabetic intervention group. homeostatic model assessment of insulin resistance (HOMA-IR) was 1.64±0.88, 6.14±0.46, and then 10.78±2.84, respectively. On comparing the results before and after EPO therapy in both intervention groups, there was a significant improvement in IR in both groups. HOMA-IR was 10.78±2.84 and 5.52±161 (P<0.001) before and after intervention, respectively, for diabetic patients, whereas it was 1.64±0.88 and 0.8±0.28 (P<0.001) before and after intervention, respectively, for nondiabetic patients. Glycated hemoglobin, fasting insulin level, as well as fasting and postprandial glucose measurements, all in both preintervension and postintervention settings were independent predictors for HOMA-IR after intervention in all 40 patients of both intervention groups. Conclusion EPO treatment in HDPs is followed by improvement of IR in diabetic as well as nondiabetic patients with end-stage kidney disease and on hemodialysis.