Role of alteration in Treg/Th17 cells' balance in nephropathic patients with Type 2 diabetes mellitus

Introduction

In type 2 diabetes mellitus, the adaptive immune system drives systemic inflammation, promoting insulin resistance and related complications, such as diabetic nephropathy. Increased infiltration of activated T lymphocytes has been found in patients with diabetic nephropathy. T-cell influx and accumulation are the factors that aggravate diabetic nephropathy and link with glomerular filtration surface and albumin excretion. An appropriate balance between pro-inflammatory (T helper 17: Th17, and T helper 1: Th1) and anti-inflammatory (regulatory T cells: Tregs) subsets of T cells is critical to maintain homeostasis and avoid inflammatory disease. The aim of this study was to determine the balance between T helper 17 and regulatory T cells in type 2 diabetic patients who have diabetic nephropathy.

Methods

This case control study was conducted between December 2013 and June 2014 in Theodor Bilharz Research Institute in Egypt. Forty patients and 20 healthy volunteers were recruited in the study, and three groups were formed, i.e. two groups of cases with 20 patients in each group and one group of 20 controls) The groups were 1) 20 type 2 diabetic patients with nephropathy (group A); 2) 20 type 2 diabetic patients without nephropathy (group B); and 3) 20 healthy individuals (control group). Evaluation of T cells was done by standard 2-color flow cytometry.

Results

The study found higher mean of Th17 counts and Th17/Treg ratio among type 2 diabetic nephropathy patients compared to other groups; but a lower mean of Treg count was identified among type 2 diabetic nephropathy patients than in the other groups (p-value = 0.001).

Conclusion

The important role for regulatory T cells in the protection against nephropathy in type 2 diabetic patients was demonstrated, and also it was observed that T helper 17 cells were associated with renal affection.

Evaluation of different sodium bicarbonate regimens for the prevention of contrast medium-induced nephropathy

INTRODUCTION

The rapid decline in renal function caused by radiographic contrast agents usually is transient, but it can result in chronic kidney disease. The pathophysiology of contrast-induced nephropathy (CIN) is poorly understood, but it may include acute hypoxia-induced oxidative stress and free radicals generated within the acid environment of the renal medulla. Thus, the alkalization of urine by sodium bicarbonate has been regarded as resulting in the reduction of CIN. The aim of this study was to determine whether a long-duration sodium bicarbonate regimen is more effective than a short-duration regimen in reducing CIN.

METHODS

One hundred patients were assigned randomly to treatment with sodium bicarbonate solution using either the short regimen (intravenous bolus 3 mL/kg/h of 166 mEq/L sodium bicarbonate for 1 hour immediately before radiocontrast) or the long regimen (initial intravenous bolus of 3 mL/kg/h of 166 mEq/L sodium bicarbonate for 6 hr). Patients with renal dysfunction (estimated glomerular filtration rate [eGFR], 60 mL/min/1.73 m(2) or less) who underwent elective or emergent coronary angiography (CAG) with/without percutaneous coronary intervention (PCI) at Nephrology Department (Theodor Bilharz Research Institute) were enrolled in the study. Data were analyzed by SPSS version 12, using Kruskal Wallis, ANOVA, Chi square test and Spearman rank correlation coefficient.

RESULTS

There was a significant increase in serum creatinine and a decrease in eGFR 48 hr post-intervention in group 1 (short regimen) with no statically difference regarding those parameters group 2 (long regimen). Serum potassium clearly was decreased significantly post procedure in both groups.

CONCLUSIONS

The results of our study indicated that the long regimen of bicarbonate supplementation was a more effective strategy to prevent CIN than the short regimen.

Evaluation of urinary FOXP3 mRNA as a biomarker of lupus nephritis in Egyptian patients with systemic lupus erythematosus

AIM

Lupus nephritis (LN) is one of the most serious complications of SLE. Tregs (Regulatory T lymphocytes) are thought to play a part in the pathogenesis of SLE. According to recent research, Foxp3, a Treg identification marker, plays a significant role in the pathogenesis of SLE. This study aimed to compare the urinary Foxp3 mRNA levels of patients with active and inactive forms of LN and healthy control subjects to see whether it played a role in disease activity.

METHODS

We measured FOXP3 messenger RNA (mRNA) expression in the urine of 50 people with active LN, 50 people with inactive lupus, and 50 healthy people.

RESULTS

We found that the expression level of FOXP3 was significantly higher in urine from patients with active LN than from subjects with inactive lupus and healthy controls (22.93 ± 4.13 vs 5.66 ± 0.47 vs 0.57 ± 0.15copy; P < 0.001).Urinary FOXP3 mRNA level significantly correlated with SLEDAI (0.000057) In the active group, urinary FOXP3 mRNA level also significantly correlated with histological activity index (< 0.00001).

CONCLUSION

We concluded that urinary FOXP3 mRNA is elevated in patients with active LN and that it is linked to the SLEDAI and the severity of the disease. FOXP3 mRNA in urine sediment may be used as a non-invasive biomarker for evaluating the severity of LN and risk stratification.

Screening of serum 25-hydroxyvitamin D levels among elderly Egyptians admitted to the orthogeriatric unit by fracture hip

Background

Vitamin D deficiency increases muscle weakness and pain leading to reduced power and function, increased bone turnover and increased risk of falls and hip fractures in elderly. We postulated that vitamin D deficiency in sunny Egypt should be lower than western countries so we screen for prevalence of vitamin D deficiency among all elderly patient admitted to orthogeriatric unit by fracture hip.

Results

Our study showed that vitamin D deficiency is common in elderly Egyptian patients admitted to orthogeriatric unit with hip fractures.

Of the study group (n 290 patients) vitamin D levels were sufficient (30 ng/dl or more) in 24 patients (8.3%) and insufficient (between 20 ng and 30 ng) in 125 patients (43.1%) and deficient (less than 20) in 141 patients (48.7%). Among the study group, female patients had lower levels of vitamin D (18.8 ± 6.9) compared to males (20.5 ± 6.7) P value 0.034.

Although our study failed to link different levels of vitamin D with activity of daily life: P value was (0.116) in bathing, (0.058) in dressing, (0.115) in toileting and (054) in transfer.

A little difference was found in feeding (0.036) and previous fall (0.011) and cognitive impairment; MiniCOG < 3 P value 0.017. Both previous falls and cognitive decline are in turn linked to increased fracture risk

Conclusion

Hypovitaminosis D is common among older patients with hip fractures even in sunny Egypt remaining slightly lower than its prevalence in western countries. Although no direct significant correlations with activity of daily life, vitamin D deficiency was associated with higher risks of previous falls and cognitive impairment both in turn increases the risk of fractures.

Incidence and Determinants of Complications of Percutaneous Kidney Biopsy in a Large Cohort of Native Kidney and Kidney Transplant Recipients

Objectives

This study aimed to determine the incidence and factors associated with complications for kidney biopsy. Percutaneous kidney biopsy is a useful diagnostic procedure. Haemorrhagic complications may occur following the procedure.

Methods

The present study retrospectively analysed the records of patients who had percutaneous renal biopsy between March 2013 and March 2018. The cohort included both native kidney and native transplant biopsies. We have included only the first biopsy for each patient; repeat biopsies were excluded from the analysis.

Results

A total of 1,198 patients (332 transplant recipients and 886 native kidney patients) were included in this study. Major complications occurred in 1.5% (n = 18) of patients (1.4% in native kidney biopsies versus 1.6% in kidney transplant recipients). Adequate renal tissue (core of >6 glomeruli) was obtained in 91% of the patients. Data analysis revealed that the incidence of major complications in the native kidney biopsy increase with an age >65 years (odds ratio = 2.4; 95% Confidence interval [CI] = 1.5–5.6), estimated glomerular filtration rate (eGFR) <30 mL/min/m² (odds ratio = 9.7; 95% CI = 3.4–18.2) and anaemia (odds ratio = 3.2; 95% CI = 1.7–5.2). In transplant recipients kidney biopsy, the incidence of complications was increased with age >65 years (odds ratio = 2.8; 95% CI = 1.7–7.3), eGFR <30 mL/min/m² (odds ratio = 11.3; 95% CI = 3.5–16.8) and anaemia (odds ratio = 2.4; 95% CI = 1.4–4.7).

Conclusion

The incidence of major complications following kidney biopsy was 1.5% for a cohort of native kidney biopsy and kidney transplant biopsies. Age >65 years, lower eGFR <30 mL/min/m² and anaemia were independent risk predictors for the occurrence of major complications in both native and transplant kidney biopsies.

Study of Serum Fibroblast Growth Factor 23 as a Predictor of Endothelial Dysfunction among Egyptian Patients with Diabetic Kidney Disease

Endothelial dysfunction in patients with diabetic nephropathy is caused by nontraditional factors in addition to common risk factors (e.g., hypertension) in people with normal kidney function. These nontraditional factors include factors involved in mineral bone disease in these patients. One of these factors is fibroblast growth factor 23 (FGF-23). We aimed to evaluate the relationship between flow-mediated dilatation (FMD) as a measure of endothelial dysfunction and FGF-23. This was a cross-sectional observational study that was conducted on 100 diabetic patients (Group I: 50 patients with nephropathy; Group II: 50 patients without nephropathy) and 50 healthy volunteers (Group III). Serum levels of intact FGF-23, interleukin-6, intact parathyroid hormone, and 25-hydroxyvitamin D (25-(OH)Vit D); estimated insulin resistance; and FMD were evaluated. FGF-23 was significantly higher in Group I (median: 101 pg/mL) and Group II (median: 101 pg/mL) than in Group III (median: 4 pg/mL) (P <0.001), but FGF-23 was not significantly different between Groups I and II. A significant positive correlation was found between serum levels of FGF-23 and phosphorus in Group I. A significant negative correlation was found between serum levels of FGF-23 and 25-(OH)Vit D in Group II. However, FGF-23 failed to show a significant correlation with FMD in patients with diabetic nephropathy. Our data suggest another factor that rises earlier than FGF-23 in diabetic nephropathy and causes endothelial dysfunction.

Retrospective analysis of nontraumatic subdural hematoma incidence and outcomes in Egyptian patients with end-stage renal disease on hemodialysis

Background

The incidence of subdural hematoma (SDH) in chronic maintenance hemodialysis (CMH) patients may change over time, along with the evolving characteristics of the underlying populations.

Methods

We conducted a retrospective, single-center study at Cairo University hospitals, assessing the incidence, associated risk factors, and outcomes of nontraumatic SDH in CMH patients between January 2006 and January 2019.

Results

Out of 1217 CMH patients, nontraumatic SDH was diagnosed in 41 (3.37%) during the study, increasing with the enrollees’ age but stable over the observation period and translating into an annual incidence rate of 28 per 1000 patients per year. SDH patients were likely to use central venous catheters, reported pruritis and history of bone fractures, and had higher phosphorus, parathyroid hormone, and alkaline phosphatase values (p < 0.001); however, there was no association with atrial fibrillation or use of anticoagulants. In the SDH cohort (n = 41), six patients did not need surgical intervention and 13 patients died before becoming surgically fit for intervention; mortality correlated with ischemic heart disease (p = 0.033) and the presence of atrial fibrillation or chronic anticoagulation with warfarin (p < 0.0001 for both), among others. Twenty-two patients received surgical operations and of these 2 died postoperatively; overall patient mortality was 12/41 (29.27%) at 30 days and 15/41 (36.59%) at 1 year.

Conclusion

Our study demonstrated a striking enrichment for underlying comorbidities in those patients developing SDH and a high risk of immediate mortality. The benefit of chronic anticoagulation therapy should be carefully weighed against the risk of CNS bleed in MHD patients.

Aerobic exercise with diet induces hormonal, metabolic, and psychological changes in postmenopausal obese women

Physical activity and diet are recommended lifestyle strategies to improve human health. Consequently, this study aimed to investigate the impact of aerobic exercise combined with dietary restriction on hormonal, metabolic, and psychological variables in postmenopausal women. Eligible 60 women were enrolled and assigned into two equal groups; the experimental group performed aerobic exercise three times per week for 12 weeks with diet restriction, and the control group only received the same diet program. Serum levels of sex hormones, insulin resistance, and depression scores were measured before and after the intervention.

Results

All measured variables were significantly changed in the experimental group compared to the control group (P = 0.001).

Conclusion

Changes in sex hormones are a biological marker of metabolic complications such as insulin resistance, which can be reduced with exercise and diet. In addition, they are effective therapeutic interventions in the treatment of mild depression.

Trial registration

Registration identifier number of this study is: NCT05136742 on https://register.ClinicalTrials.gov.