Role of some mycotoxins in inducing kidney diseases in upper Egypt

Egypt has a climate that favors the growth of fungi specially those producing mycotoxins. Mycotoxins are found all over the world in human food and blood as well as in animal blood and tissues. The most threatening effects are their nephrotoxicity and carcinogenicity. The aim of this study was to identify the role of some mycotoxins namely; ochraloxin A [OTA] and fumonisin B[1] [FB1] in the occurrence of chronic renal disease of unknown aetiology in Upper Egypt. This study was carried out on 134 subjects who were classified as: 47 patients suffered from chronic renal failure of unknown aetiology before dialysis treatment [group A], 35 subjects who were relatives of patients in group A considering that they share them in the same environmental conditions [group B], 28 subjects working in the Middle Egypt Company [MEC] for grinding of cereals as an occupational risk group for exposure to inhalation of mycotoxins [group C] and 24 subjects with normal kidney functions as a control group. They exposed to a detailed history, their occupation, family history and kidney function tests. Indices of early kidney affection and levels of OTA and FB[1] in urine and serum for all subjects in all groups were also done. As regard group A, OTA was significantly increased while FBI was non-significantly increased in both serum and urine of patients compared to control group. There was positive correlation between the levels of OTA in both serum and urine versus the level of blood urea. It was found also that the patients with positive ochratoxicity had mild proteinuria. As regard group B, OTA and FB[1] were detected in urine and plasma, although with levels lower than that in group A but significantly higher than that of controls. As regard group C, OTA was found to be nearly equal to that in controls both in serum and urine which may indicate the low contamination levels of cereals in MEC due to good storage conditions. However, FB[1] was found in serum to be insignificantly higher than that in groups A and controls. Also FB[1] was detected in urine insignificantly lower than that in group A and insignificantly higher than that in controls. Although the results were statistically non significant but may indicate the increased risk of exposure to FB[1] in this group. We concluded that the presence of OTA and FB[1] in serum and urine of our control group may indicate the presence of these two mycotoxins as contaminants in the food in our locality. Also, these toxins may play a role in inducing chronic renal diseases in our locality. We advise a continuous follow up for all subjects exposed to these toxins, giving instructions about ways for protection and treatment as well as good storage for cereals and foods

Survey study of microalbuminuria in diabetic patients attending out-patient clinic of diabetes in Assiut University Hospital

Micro albuminuria is the earliest sign of diabetic nephropathy [DNP] and it is an indicator for the presence of the characteristic glomerular lesion. This study was conducted on the adult diabetic patients of both types I and II of diabetes mellitus [DM] attending the out -patient clinic of Assiut University Hospital throughout the year 2002. Patients with hypertension, congestive heart failure or those with urinary tract infection albuminuria were excluded. Five hundred patients were subjected to full history taking and clinical examination as well as the following investigations; [I] complete urine analysis [2] screening for micro albuminuria [3] fasting serum glucose [FSG]] and glycosylated hemoglobin [HbAlc] [4] serum urea and creatinine and creatinine clearance. Out of 500 patients 213 [42.6%] were positive for micro albuminuria which was more prevalent among type I DM, male sex, extreems of age, urbans, over-weight and obese patients and those with low physical activities as well as patients with non renal complications. Significant direct proportions were found between level of micro albuminuria, on one hand, and level of FSG and HbAlc and serum urea and creatinine on the other hand, while inverse proportion was found with creatinine clearance. We have concluded that, micro albuminuria is a simple detectable marker for screening incipient DNP. Micralbuminuria was prevalent among considerable percentage [42.6%] of our diabetic patients. It was found to be more prevalent among different studied categories of patients which could be considered as possible risk factors for developing DNP in our locality. Apart from hypertension, these factors are [1] type I DM [2] male sex [3] extreems of age [4] urbans [5] low physical activities [6] obesity [7] long duration of DM [8] bad control of hyperglycaemia [9] presence of non renal complications [10] renal insufficiency

Prevalence of symptomless proteinuria among school children in Assiut

In a trial to assess the prevalence of symptomless proteinuria among healthy rural and urban school children, 3029 subjects of both sexes, aged from 6-12 years were screened using sulphosalicylic acid method. The prevalence rate of proteinuria was 14.5%. It was significantly higher [P < 0.001] in subjects in rural than those in urban areas [16% versus 9.7%]. Within the groups of males, females, those > 8-10 and > 10-12 years of age there was a significant increase in the prevalence rate among chidren from rural areas. In addition, the prevalence rate was significantly increased with increasing age in rural areas. The highest rate was found among children aged > 10-12 years [21.3%] in rural and among those aged 6-8 years [11.8%] in urban areas. However, no significant differences were observed between males and females of the two communities. The prevalence rates of microscopic haematuria and positive urine for schistosoma ova among proteinuric children were significantly higher among subjects in rural than in those in urban areas and within groups of males and females of rural than of urban but no significant differences between both sexes of the two communities. We recommend routine urine analysis annually for all school children and further investigating those with proteinuria

Hepatitis B virus and HIV infection among hemodialysis patients and staff in Assiut renal dialysis units

Screening of 312 patients with chronic renal failure on regular hemodialysis and 64 staff members caring for them in three hemodialysis centers in Assiut for hepatitis B surface antigen [HbsAg], anti-hepatitis B core [anti-HBc] and antihuman immunodeficiency virus [anti-HIV] was done over a period of 2 years [1989 and 1990] by ELISA technique. HBs Ag was detected in 24 [7.69%] patients and anti-HBc in 59 [18.91%] patients, while 18 [5.76%] patients showed both markers. The prevalence of HbsAg was significantly related to the duration of hemodialysis but neither to the number of transfused blood units nor to the age of the patient. In staff members, HBs Ag was detected in 5 [7.81%], anti-HBc in 9 [14.06%] and both markers in 2 [3.13%]. High percentage [15.79%] of HbsAg was found among physicians and those with duration of employment over one year although the differences were statistically insignificant. We have found two seropositive cases for anti-HIV among hemodialysis patients by ELISA technique, but only one of them was positive by the confirmatory Western blot test. In staff members, no single positive case was detected. HBV and HIV infection are major problems in hemodialysis centers, thus infection control precaultions must be done

HLA system in schistosomal and non-schistosomal nephrotic syndrome

The human leucocyte antign [HLA] phenotypes [HLA, A-A, -B and -C antigens] were typed in 62 Upper Egyptian nephrotic patients and the results were compared with 400 ethnically similar normal controls. Patients were classified into 2 clinicopathological groups. Group I of 24 schistosoma hematobium associated nephrotics and group II of 38 non schistosomal nephrotic patients. Schistosoma-associated nephrotic patients showed significant association with HLA-A9, -B15 and CW3, while non schistosomal nephrotic patients showed significant association with HLA-A9, -B5, -B27 and CW3 in comparison with the control group. Nephrotic patients showed significant association with the haplotypes A9 CW3, B5 CW3 and B27 CW3 when compared to the control group. Also we found a significant linkage disequilibrium between HLA-CW3 and - HLA-A9, B5 and B-27 in the control group. We suggest that HLA-CW3 is the genuine antigen associated with nephrotic syndrome in Upper Egypt, and the associated increase in HLA-A9, -B5 and -B27 was due to their linkage disequilibrium with HLA-CW3