Proteinuria in Egyptian renal transplant recipients.

To evaluate the prevalence, risk factors, possible etiology, prognosis and management of proteinuria in renal transplant recipients, we studied 435 adult renal transplant recipient patients randomly selected from our center; 394 patients were reviewed retrospectively and 41 patients were followed-up prospectively for a period of one year. The patients were classified into three groups according to the results of urinalysis and spot urinary albumin creatinine ratio: Group A patients with normoalbuminuria; Group B patients with microalbuminuria; and Group C patients with macroalbuminuria. Persistent post-transplantation proteinuria was detected in 125 (28.8%) patients. The etiology of post-transplantation proteinuria included chronic allograft dysfunction in 44 (35.2%) patients, acute rejection in 40 (32%) patients, transplant glomerulopathy in eight (6.4%) patients, glomerular disease in 16 (12.8%) patients and other etiology in 17 (13.6%) patients. Proteinuric patients demonstrated significantly lower graft survival rates than did those without proteinuria (48.3% versus 51.7%, respectively; P = 0.017; Risk Ratio = 0.403; 95% confidence interval 0.188-0.862). We conclude that proteinuria is prevalent after kidney transplant in our population, and that it is most commonly associated with chronic allograft nephropathy, transplant glomerulopathy, glomerulonephritis and acute rejection. Post-transplant proteinuria is associated with decreased allograft survival.

Body mass index and the risk of progression of chronic kidney disease.

OBJECTIVE: To examine the independent relationship between obesity, as estimated by body mass index (BMI), and progression of chronic kidney disease. We hypothesized that BMI would be associated with decline in estimated glomerular filtration rate (eGFR), independent of diabetes mellitus, hypertension, and other risk factors for progression of chronic kidney disease. DESIGN: A retrospective cohort study was carried out. SETTING: The study was carried out at Nephrology ambulatory clinics of the London Health Sciences Centre, Canada. PATIENTS: The study included incident and prevalent patients with eGFR <60 mL/min/1.73 m(2). Eligible patients were observed between the calendar years 2005 and 2007. Subjects were excluded on the basis of <12 months of follow-up, age <18 years, or past kidney transplantation. INTERVENTION: Least-squares regression was used to estimate change of eGFR over time. Baseline clinical and demographic factors, including BMI and diabetes, were examined in univariate and multivariate analyses. MAIN OUTCOME MEASURE: Change in eGFR over time was assessed in this study. RESULTS: A total of 214 subjects were observed for a mean of 4.48 ± 1.84 years. In univariate analysis, BMI was not statistically associated with eGFR change as either a continuous or a categorical variable. Using a BMI cut-off of 30 kg/m(2), no statistical difference in slope of eGFR was found, with a decline of 2.2 mL/min/1.73 m(2) per year in the nonobese group, and 2.69 mL/min/1.73 m(2) per year in the obese group (P = .13). Multivariate analysis demonstrated high baseline eGFR, proteinuria, and diabetic nephropathy to be associated with a faster decline in eGFR. Use of renin-angiotensin-aldosterone blockade was associated with an improved slope of eGFR over time. CONCLUSION: Our results do not support the hypothesis that obesity is independently associated with a decline in kidney function.

Prevalence of hyperkalemia among hemodialysis patients in Egypt.

INTRODUCTION: Hyperkalemia is a frequent problem in patients with end stage renal disease (ESRD) on maintenance hemodialysis and is often attributed as a cause of deaths in these patients. The aim of this study was to estimate the prevalence of hyperkalemia among Egyptian hemodialysis patients. PATIENTS AND METHODS: 400 ESRD patients on maintenance hemodialysis were enrolled in the study. They were allowed their usual diets and medications during the study periods. For all patients, history and clinical examinations and serum potassium level was measured three times--pre- and post-1st session and pre-next session--at two successive sessions of hemodialysis. RESULTS: The results of this study showed that the prevalence of hyperkalemia was 41.2%, 6.5%, and 66.9% of pre- and post-dialysis and before the next session of dialysis, respectively. Hyperkalemia significantly correlates with potassium-rich diets, non-compliant patients, two sessions of hemodialysis per week, and constipation in ESRD patients during the study periods. Serum potassium level was significantly higher in anuric ESRD patients than those who had residual renal function, patients using acetate dialysate than those using bicarbonate dialysate, and patients with low blood flow rate than those with higher blood flow rates. There was a non-significant correlation between serum potassium and ACEls, B-blockers, or diabetes. CONCLUSION: Hyperkalemia is a frequent problem in patients with end stage renal disease in Egypt. Hyperkalemia significantly correlates with a potassium-rich diet and inadequate dialysis either by prescription or non-compliance. Thrice weekly bicarbonate dialysis with higher blood pump flow rate had better elimination of potassium.

Effect of recombinant human erythropoietin on insulin resistance in hemodialysis patients.

Insulin resistance is a characteristic feature of uremia. Insulin resistance and concomitant hyperinsulinemia are present irrespective of the type of renal disease. Treatment with recombinant human erythropoietin (rHuEPO) was said to be associated with improvement in insulin sensitivity in uremic patients. The aim of this study was to compare insulin resistance in adult uremic hemodialysis (HD) patients including diabetic patients treated with or without rHuEPO. A total of 59 HD patients were studied, patients were divided into 2 groups of subjects: 30 HD patients on regular rHuEPO treatment (group A), and 29 HD patients not receiving rHuEPO (group B) diabetic patients were not excluded. Full medical history and clinical examination, hematological parameters, lipid profile, serum albumin, parathyroid horomone, Kt/V, fasting glucose, and insulin levels were measured in all subjects. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was used to compare insulin resistance. The results of this study showed that the mean insulin level of HD patients treated with rHuEPO (group A) (17.5 +/- 10.6 microU/mL) was significantly lower than patients without rHuEPO (group B) (28.8 +/- 7.7 microU/mL), (P<0.001). Homeostasis Model Assessment of Insulin Resistance levels in group A were significantly lower than in group B (3.8 +/- 2.97, 7.98 +/- 4.9, respectively, P<0.001). Insulin resistance reflected by HOMA-IR levels among diabetic patients in group A was significantly lower than among diabetic patients in group B (3.9 +/- 3.2, 9.4 +/- 7.2, respectively, P<0.001). Also, HOMA-IR levels among nondiabetic patients in group A were significantly lower than among nondiabetic patients in group B (3.7 +/- 2.85, 6.9 +/- 1.43, respectively, P<0.01). We found a statistically significant negative correlation between duration of erythropoietin treatment, fasting blood glucose, insulin levels, and insulin resistance (r=-0.62, -0.71, and -0.57, P<0.001). Patients treated with rHuEPO showed less insulin resistance compared with patients not treated with rHuEPO in diabetic and nondiabetic patients and, duration of erythropoietin treatment is negatively correlated with insulin levels and insulin resistance in HD patients.