A Pre-Post Study of Vitamin D Supplement Effects on Urinary Megalin: The Emerging Predictive Role of Megalin in Diabetic Nephropathy Progression.

INTRODUCTION: Megalin is a renal proximal tubular protein that reabsorbs vitamin D from glomerular filtrates. Previous studies found significantly higher levels of urinary megalin in chronic microvascular complications of diabetes with associated metabolic derangements. This study aimed at testing the effect of vitamin D supplements on urinary megalin levels in diabetic nephropathy (DN) patients with vitamin D hypovitaminosis. METHODS: Sixty-three participants with vitamin D deficiency and diabetic nephropathy (DN) were enrolled in the pre-post study; urinary megalin levels with various clinical parameters and serum levels of vitamin D3 were measured and compared to the baseline at 3- and 6-month intervals. RESULTS: Interestingly, a supplementation related increase in serum vitamin D3 levels at 3- and 6- month interventions affected a constellation of ameliorations in the DN progression of clinical and metabolic factors. There was a decrease in ACR with a concomitant decrease in urinary megalin and a decrease in blood pressure, fasting plasma glucose (FPG), and low-density lipoprotein - cholesterol (LDL-C) - but an increase in glomerular filtration rate (GFR). Principally, pellet urinary megalin associated positively (p < 0.05) with vitamin D hypovitaminosis and the albumin-to-creatinine ratio (ACR) but negatively (p < 0.05) with Ca2+ and body mass index (BMI). CONCLUSION: Vitamin D supplementation could elucidate underlying pathophysiological mechanisms and a prognostic significance of urinary megalin association with DN, obesity/MetS-related dyslipidemia, and hyperglycemia modification. Megalin is a putative sensitive and precise predictive marker and an emerging therapeutic target of renal anomalies.

Multiple Myeloma in a Patient with Focal Segmental Glomerulosclerosis: A Case Report.

BACKGROUND Focal segmental glomerulosclerosis (FSGS) is a common cause of nephrotic syndrome in adults, which can be primary, or secondary to various causes. Unlike membranous nephropathy, FSGS is less likely to be associated with malignancy. Few cases have been reported of the occurrence of FSGS with hematological malignancies like multiple myeloma (MM). CASE REPORT A 48-year-old man presented with nephrotic syndrome and renal impairment and was diagnosed with primary FSGS after kidney biopsy, which showed a segmental scar with diffuse effacement of foot processes on electron microscopy. Treatment with steroids reduced proteinuria and stabilized the renal function. A few months later, the patient presented with acute Kidney Injury, bone pain, and anemia. A diagnosis of MM was made based on the bone marrow biopsy. Treatment of MM decreased proteinuria and improved renal function. CONCLUSIONS There is an association between FSGS and MM through an unclear mechanism.

Blood Pressure and Its Association with Gender, Body Mass Index, Smoking, and Family History among University Students.

Hypertension is one of the major risk factors associated with cardiovascular diseases. In this study, we will assess the frequency of hypertension among healthy university students and its association with gender, body mass index, smoking, and family history of both hypertension and cardiovascular diseases. We screened healthy university students ranging from 18 to 26 years of age. For each participant, we performed blood pressure measurements using a previously validated device and obtained demographic data, body mass index (BMI), smoking status, and family history of both hypertension and cardiovascular diseases. Out of the total number of 505 participants included in this study, 35.2% have blood pressure between 130/80 and 139/89, and 13.5% have blood pressure of more than 140/90. We found significant gender differences in both systolic pressure (p = 0.003) with mean difference = 18.08 mmHg (CI: 16.13 to 19.9) and diastolic pressure (p = 0.011) with mean difference = 3.6 mmHg (CI: 2.06 to 5.14), higher in males than in females. Upon comparing the mean difference in both systolic and diastolic blood pressure with BMI, we found significant differences in both systolic (p < 0.001) and diastolic (p = 0.002) blood pressure. We also found that smokers have significantly (p = 0.025) higher systolic blood pressure (mean difference = 4.2 mmHg, CI: 3.2 mmHg to 8.8 mmHg), but no significant difference for diastolic blood pressure (p = 0.386), compared to nonsmokers. First-degree family history of both hypertension and cardiovascular diseases affected systolic but not diastolic blood pressure. Taking into account the adverse short- and long-term effect of hypertension, we recommend adopting an awareness program highlighting the importance of screening blood pressure in young adolescent populations, keeping in mind that both high BMI and smoking are important modifiable factors.