Lactoferrin: A Promising New Player in Treatment of Iron Deficiency Anemia in Patients on Regular Hemodialysis: A Randomized Controlled Trial.

Hepcidin is secreted in inflammatory states as in patients on regular hemodialysis (HD). Therefore, novel agents modulating hepcidin secretion may have the potential to effectively reverse anemia in HD patients. Bovine milk derivative lactoferrin (BLF) is a glycoprotein that was found to decrease serum interleukin-6, therefore, having anti-inflammatory properties. Thus, it can downregulate hepcidin secretion in various inflammatory states including patients on regular HD, so improving iron absorption and utilization in those patients. In addition, BLF is a source of iron as each BLF molecule chelates two ferric ions. We started an interventional study. Seventy patients on regular HD with iron deficiency anemia received 100 mg of 20%-30% iron-saturated BLF (corresponding to 70-84 µg of elemental iron) orally b.i.d for 6 months. We compared those patients with another 70 patients on regular HD with iron deficiency anemia who were given 576 mg of ferrous glycine sulfate (corresponding to 100 mg of elemental iron) orally b.i.d for 6 months. BLF significantly decreased serum hepcidin level (from 340-350 ng/mL to 101-112 ng/mL), P <0.0001 and significantly increased hemoglobin (Hb) concentration (from 7.5-8.1 g/dL to 9.3-10 g/dL), P <0.0001, and transferrin saturation (TSAT) (from 5%-9% to 26%-31%), P <0.0001. Furthermore, ferrous glycine sulfate significantly decreased serum hepcidin level (from 335-350 ng/mL to 330--341 ng/mL), P <0.0001, and significantly increased Hb (from 7.5-8.1 to 7.6-8.5 g/dL), P <0.0001, and TSAT (from 5%-9% to 7%-12%), P <0.0001. However, the magnitude of decrease in serum hepcidin level and rise in Hb and TSAT in the BLF group was significantly higher than in the ferrous glycine sulfate group, P <0.0001. Oral BLF can be considered a promising novel agent in treatment of iron deficiency anemia in patients on regular HD.

Assessment of Lupus Nephritis in a Multicenter Retrospective Egyptian Cohort: Initial Characteristics, Influence of Age and Gender, Outcome, and Potential Association with Disease Damage.

The study aimed to evaluate the association of demographic, clinical, and histopathologic characteristics with renal and disease outcomes. Persistent lack of partial or complete remission despite sequential induction therapy, chronic kidney disease (CKD) or endstage renal disease (ESRD), and/or mortality were determined as poor renal outcomes. Disease damage was investigated through the Systemic Lupus International Collaborating Clinics/ American College of Rheumatology Damage Index (SDI). Of 201 biopsy-proven lupus nephritis patients, a poor outcome was present in 56 (27.9%) patients, with nine (4.5%), 22 (10.9%), and 29 (14.4%) patients demonstrating lack of response, CKD, and ESRD, respectively, and the prevalence of mortality was 5.5% (11/201). The outcome was poor among males [29/201 (14.4%)] [P = 0.008; odds ratio (OR): 2.8; 95% confidence interval (CI): 1.2-6.4], yet comparable between adult- and juvenile-onset patients [80/201 (39.8%) (≤16 years)] (P = 0.6; OR: 0.8; 95% CI: 0.4-1.6). Hypertension (P <0.001; OR: 6.3; 95% CI: 2.6-14.9), elevated creatinine (P <0.001; OR: 5.2; 95% CI: 2.6-10.3), and hematuria (P <0.001; OR: 3.7; 95% CI: 1.9-7.5) at presentation, and fibrinoid necrosis [P <0.001; odds ratio (OR): 4.1; 95% confidence interval (CI): 2.1-8.1], wire loops (P = 0.006; OR: 2.4; 95% CI: 1.2-4.6), crescents (P <0.001; OR: 5.4 95% CI: 2.8-10.5), interstitial fibrosis (P = 0.001; OR: 2.7; 95% CI: 1.4-5.1), and acute vascular lesions (P = 0.004; OR: 3.6; 95% CI: 1.4-9.4) on biopsy were associated with a poor outcome. Chronic glomerular (P = 0.003) and acute vascular lesions (P <0.001), and a higher chronicity index (r = 0.1; P = 0.006) on biopsy, and frequent renal (r = 0.3; P <0.001) and extra-renal flares (r = 0.2; P <0.001) were associated with higher SDI scores. Among the studied renal and extra-renal parameters, independent predictors of higher disease damage solely included frequent renal flares (ᵝ= 1; P <0.001). To conclude, a poor renal outcome (27.9%) was associated with distinct features. Disease damage was associated with frequent renal flares.

Serum Urate Lowering Therapy Using Allopurinol Improves Serum 25 Hydroxy Vitamin D in Stage 3-5 CKD Patients: A Pilot Study.

BACKGROUND: Recent studies have demonstrated negative associations of serum uric acid (SUA) with serum 25 hydroxy vitamin D (25 [OH] vit D) among CKD patients. OBJECTIVE: The aim of the study was to look for the impact of hypouricemic therapy using allopurinol on serum level of 25 (OH) vit D in CKD patients. CASES AND METHODS: Seventy-two CKD stage 3-5 patients were selected to this study. Patients with SUA above 7 mg/dL were allocated to hypouricemic therapy using allopurinol (group I). A control group of cases not suffering marked increase in SUA were included as control group (group II). All cases were followed up for 3 months. Serum Cr, SUA, ionized calcium (SiCa), phosphorus, 25 (OH) vitD, parathyroid hormone (PTH), and 24-h urine protein were estimated at entry and by the end of the study. RESULTS: At least 20 cases completed the study in each group. Serum 25 (OH) vit D significantly increased in group I (26.4 [14.1] vs. 39.6 [14.8] at entry vs. at end of the study, p < 0.001). In addition, SUA, PTH, and urine protein significantly decreased (11 [1.6] vs. 3.95 [0.58] mg/dL, 267.5 [97.5] vs. 225.5 [153] ng/mL, and 2.7 [1.18] vs. 1.5 [1.08] gm/day, p < 0.001, = 0.043, and <0.001 respectively). SiCa and phosphorus significantly increased (4.4 [0.3] vs. 5.2 [0.5] mg/dL and 4.25 [0.72] vs. 4.9 [0.75] mg/dL, p < 0.001 and = 0.007, respectively). CONCLUSION: This study supports a negative causal relationship between SUA and serum 25 (OH) vit D. Further studies are still needed to confirm this conclusion.

Intraosseous cavernous hemangioma of the frontal bone.

A 32-year-old man presented with a primary intraosseous cavernous hemangioma manifesting as a small painless swelling of the right forehead. Radiography revealed a radiolucent osteolytic lesion in the right frontal region. Bone window computed tomography demonstrated a 1.5 cm mass between the outer and inner tables just lateral to the right frontal sinus. The outer and inner tables were thin and partially defective, but without bone fracture. Magnetic resonance imaging revealed a small mass lesion with bone erosion of the posterior table of the frontal bone. Preoperative examination yielded no final diagnosis. En bloc resection was performed. The histological diagnosis was primary intraosseous cavernous hemangioma. Total resection is recommended for definitive diagnosis of intraosseous tumor.