The nature and prognosis of renal diseases in chronic hepatitis-C-infected diabetic Egyptian patients: The role of renal biopsy

BACKGROUND AND AIMS

Egypt has a wide prevalence of Diabetes and chronic HCV infection. The relationship between diabetes and HCV is bidirectional and both have their impact on kidney. The aim is to study the exact diagnostic and prognostic significance of renal biopsy in Diabetic HCV-infected patients with renal disease.

MATERIAL AND METHODS

In this cross-sectional study, we compared the clinical and histopathological characteristics of sixty-five patients all of them presented with evidence of kidney injury. The main study group included twenty patients who had DM and hepatitis c virus (DM-HCV); the other two groups were included as diseased control, twenty hepatitis c virus (HCV) patients, and twenty-five diabetic non-HCV patients (DM).

RESULTS

DM-HCV patients had a statistically significantly higher percentage of sclerosed glomeruli (Median Value of 44.5% versus 7% in DM and 7% in HCV). The tendency toward diffuse (20%) and global (75%) patterns of sclerosis as well as moderate to severe tubular atrophy (45%), moderate to severe interstitial fibrosis (55%) were reported in the DM-HCV group. Electron microscopic showed a significantly higher frequency of podocytopathies (70% in DM-HCV versus 12% in DM).

CONCLUSION

These results confirmed the diagnostic and prognostic significance of histopathological evaluation in guiding the management plan which cannot be replaced by just relying on clinical prediction.

Impact of treatment of dyslipidemia on renal function, fat deposits and scarring in patients with persistent nephrotic syndrome

In this study 43 patients with idiopathic nephrotic syndrome were randomly distributed into 2 age- and sex-matched groups. The first group was given fluvastatin while the second was used as control. The cases in the 2 groups were evaluated clinically, biochemically (creatinine clearance, albumin, 24-hour proteinuria, and lipogram), neurologically, and histopathologically (examination of renal biopsies obtained basally and after 1 year of treatment with fluvastatin). In the fluvastatin-treated group but not in the control group, we observed a significant reduction in cholesterol, low-density lipoprotein, and triglyceride. Clinical and laboratory assessment showed satisfactory tolerance of the drug by the patients. Proteinuria, serum albumin and creatinine clearance values were significantly better in the statin-treated patients. There was no difference in glomerular sclerosis between the 2 groups while interstitial fibrosis and renal fat deposits were less in the statin-treated group. The reduction in renal fat deposits in the statin-treated group was highly significant, while that of interstitial fibrosis was not. We conclude that: (1) statin can be safely and effectively used in the treatment of dyslipidemia in patients with persistent idiopathic nephrotic syndrome; (2) control of dyslipidemia in nephrotic patients is associated with better control of proteinuria and creatinine clearance; (3) statin treatment may cause regression of renal fat deposits in patients with nephrotic syndrome, and (4) longer term studies are still required to study further possible beneficial effects on renal histology and disease progression.