Background and Aims Volume overload is considered as an important clinical problem in HD patients. It is associated with morbid situations such as pulmonary hypertension and lung congestion. to assess the effect of increased (IDWG) on... more
Background and Aims Volume overload is considered as an important clinical problem in HD patients. It is associated with morbid situations such as pulmonary hypertension and lung congestion. to assess the effect of increased (IDWG) on pulmonary hypertension, and lung congestion. Method This observational cross sectional study was conducted at on 60 HD patients, that were divided into Group I: 30 patients with an IDWG < 3.5% and, Group II: 30 patients with an IDWG > 3.5% of their dry weight. Pulmonary artery pressure was measured by echo and patients classified according to PAP into mild, moderate and severe pulmonary hypertension. Lung congestion in all patients was measured by lung ultrasound and patients classified into minimal, mild, moderate and severe lung congestion. Results Our study showed that pulmonary hypertension prevalence was 30% while lung congestion was 100%. Patients with increased IDWG > 3.5% (group 2) had pre HD higher PAP than those with IDWG < 3.5% (group 1) and patients with IDWG > 3.5% had more change in their PAP post HD session than those with IDWG < 3.5% but no significant difference between the change after the HD session in both groups. HD duration is an important factor in PH development over years. There is a significant relation anemia and hypercalcemia with PH. Patients with more increased IDWG > 3.5 % (group 2) had higher pulmonary congestion than those with IDWG < 3.5% (group 1) and patients with IDWG < 3.5% had more change in their lung congestion level after the HD session than those with IDWG > 3.5% but no statistical significance between the change in both groups. There was a significant relation between HD therapy duration with pulmonary congestion measured prior to the session. Conclusion on the short term increased IDWG affect lung congestion more than pulmonary hypertension.
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A patient registry is the collection of uniform data (clinical and others) to evaluate specified outcomes for a population defined by a particular disease or therapy (target disease or therapy) and that serves one or more predetermined... more
A patient registry is the collection of uniform data (clinical and others) to evaluate specified outcomes for a population defined by a particular disease or therapy (target disease or therapy) and that serves one or more predetermined scientific, clinical, or policy purposes. Our aim is to establish a renal database for hemodialysis patients (as a first step) that would help in providing the optimal health care to improve quality of life and prolong survival. Egyptian renal data system (ERDS) was established out of the firm belief that delivering a clear picture of the incidence, prevalence, and outcomes of hemodialysis-related problems in Egypt is the needed action to identify the real magnitude of the problem. ERDS is the Egyptian national registry of nephrology patients. It was founded and is run by the Egyptian Society of Nephrology and Transplantation (ESNT), the only official Egyptian Non-Governmental Organization representing nephrologists and officially managing some issues of the nephrology specialty in Egypt. ERDS until now registers data about patients with End stage kidney disease (ESKD) on chronic hemodialysis, but the plan is to include more patient groups in the future. Two types of data were collected; data about the dialysis units as a whole and data specific to each patient. Data entered by all units were exported from the digital system as a .csv file that can be opened by Microsoft Excel. Data analysis was carried out by Microsoft Excel functions and Microsoft Power Business Intelligence. Results were represented by different sectors.
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Background Heart valve calcification was first described a century ago. Its pathologic features were first described by Dewitsky in 1910. Valvular heart disease is common in end-stage renal disease patients. The incidence of valvular... more
Background Heart valve calcification was first described a century ago. Its pathologic features were first described by Dewitsky in 1910. Valvular heart disease is common in end-stage renal disease patients. The incidence of valvular heart disease is 5 times greater in dialysis patients than in the general population MGP plays a key role in the inhibition of tissue calcification, which was demonstrated in MGP-deficient mice Objective To detect the prevalence of cardiac valvular calcifications among end stage renal disease patients on prevalent haemodialysis and its relation to Matirx Gla protein. Patients and Methods Enrolled patients were recruited from Ain shams hospitals, divided into two groups according to the presence/absence of valvular calcifications on echocardiographic examination as follows: Group A: included patients with valvular calcifications. Group B: included patients without valvular calcifications. Results In current study, 19 (23.8%) patients showed mitral calcif...
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Background and Aims Microalbuminuria is one of the early presentations of diabetic kidney disease that may progress to macroalbuminuria, progressive loss of glomerular filtration rate and eventually end stage renal disease. Early... more
Background and Aims Microalbuminuria is one of the early presentations of diabetic kidney disease that may progress to macroalbuminuria, progressive loss of glomerular filtration rate and eventually end stage renal disease. Early recognition and management of microalbuminuria can avert irreversible complications. Antihypertensive medications and antihyperlipidemic medications are medications that have been used to control diabetic nephropathy, but the reports of some side effects limited the usage of some of these drugs in diabetic patients. Pentoxifylline is an anti-inflammatory medication that have been experienced for clinical trials in diabetic patients with diabetic kidney disease. Effect of Pentoxifylline on albuminuria has been evaluated in several studies with different outcomes where a significant decrease in albuminuria in the Pentoxifylline group compared with placebo was the final conclusion. The aim of our study is the assessment of the value of Pentoxifylline addition ...
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Background Intradialytic hypertension (IDH) is a major problem affecting 5–15% of patients with end-stage renal disease on maintenance hemodialysis (HD). We evaluated the changes of endothelin-1 (ET-1) levels during HD and its relation to... more
Background Intradialytic hypertension (IDH) is a major problem affecting 5–15% of patients with end-stage renal disease on maintenance hemodialysis (HD). We evaluated the changes of endothelin-1 (ET-1) levels during HD and its relation to IDH. Patients and methods We divided 48 stable HD patients into two groups: group I included 24 HD patients with IDH, and group II included 24 HD patients with well-controlled blood pressure (BP). Diabetic patients, patients taking angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs), and patients with severe infection, malignancy, or having decompensated liver cell failure were excluded from this study. For all patients, BP measurement was done before HD session and every half an hour throughout the sessions. ET-1 level was measured using enzyme-linked immunosorbent assay technique; three samples (before session, when BP rises during session, and at end of session) were taken from group I patients, and one sample was taken before the session in group II patients. Results Group I had significantly lower dry weight than group II (59.9±16 vs.71.5±11 kg) but a significantly higher ultrafiltration volume (2 vs. 1.5 l). There was a significant positive correlation between basal ET-1 and diastolic blood pressure after dialysis (r=0.51, P<0.05). In this study, basal ET-1 level had a significant moderate diagnostic performance in prediction of IDH (P< 0.001). Basal ET-1 more than or equal to 100 pg/ml had 100% specificity, 75% sensitivity, and 87.5% diagnostic accuracy in prediction of IDH, leading to suggestion that ET-1 was a significant risk factor for having IDH (P<0.05). Conclusion High ET-1 is a significant risk factor for having IDH, and basal ET-1 level had a significant moderate diagnostic performance in prediction of IDH.
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Background and aim: HD patients using dialysis catheters have been associated with chronic inflammatory state. In Egypt 6.6% of HD patients use catheters, of which short term catheters represent 59.6% and 40.4% with long-term catheters.... more
Background and aim: HD patients using dialysis catheters have been associated with chronic inflammatory state. In Egypt 6.6% of HD patients use catheters, of which short term catheters represent 59.6% and 40.4% with long-term catheters. In this study, we aimed to assess the effect of Taurolidine citrate and unfractionated heparin combination (Taurolock-hep500™) as a lock solution compared to unfractionated heparin alone on inflammatory markers, incidence of catheter related blood stream infections (CRBSI) and dialysis adequacy in HD patients with temporary HD catheters only, for 4 weeks duration. Methods: Sixty ESRD patients from hemodialysis units in Ain-Shams University hospitals (ASUH) at the time of catheter insertion we enrolled in our study. They were randomized into two groups: Group 1: Thirty patients received Taurolock-hep500™ as a catheter lock solution at the end of each hemodialysis session. Group 2: Thirty patients received unfractionated heparin as a catheter lock solu...
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Department of Internal Medicine & Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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Plasmapheresis is a procedure in which extracorporeal separation of blood component results in a filtered plasma product via centrifugation or the use of semipermeable membranes. Plasmapharesis is used when a toxic substance as... more
Plasmapheresis is a procedure in which extracorporeal separation of blood component results in a filtered plasma product via centrifugation or the use of semipermeable membranes. Plasmapharesis is used when a toxic substance as immunoglobulin present in the plasma and so can be removed. It is considered as first line therapy for different diseases including the renal and non-renal diseases. Some of the renal causes for plasmapharesis are renal transplant rejection that is antibody-mediated, Goodpasture’s syndrome, Recurrent focal segmental glomerular sclerosis, and catastrophic antiphospholipid syndrome. Some of the neurological disorders that need plasmapharesis as acute Guillain–Barré syndrome, Chronic inflammatory demyelinating polyneuropathy, Myasthenia gravis and paraproteinaemias associated Polyneuropathy. Metabolic indication as Familial hypercholesteremia. Microvascular angiopathy as Thrombotic thrombocytopenic purpura, atypical hemolytic uremic syndrome. The replaced fluid ...
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Background: Hemodialysis patients (HD) always suffer from fatigue, which is associated with poor healthrelated quality of life (HRQoL) in this population. Purpose: To evaluate the intensities of fatigue in HD patients, we evaluated the... more
Background: Hemodialysis patients (HD) always suffer from fatigue, which is associated with poor healthrelated quality of life (HRQoL) in this population. Purpose: To evaluate the intensities of fatigue in HD patients, we evaluated the impact of selenium and thiotacid on their fatigue level and the reflection of their antioxidant effect on HRQoL. Methods: This study was a prospective, randomized controlled clinical trial. It was carried out in two dialysis units of Ain Shams University Hospitals. The study protocol was approved by the Research Ethics Committee (REC), Faculty of Medicine, Ain Shams University, No. (FMASU MD, 381/2018). Informed consent was obtained from all individual participants included in the study. Between August 2018 and January 2019, HD patients who completed the Arabic Translated form of the Fatigue Severity Scale (FSS). FSS was assessed at baseline and three months after starting therapy with selenium or thiotacid. Results: All HD patients were suffering fro...
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Background and Aims Hypertension prevalence among ESRD patients range from 76% to 90%. Sodium & volume overload is among the main mechanisms. Increasing theduration of dialysis time, either by longer session hours or increased sessions,... more
Background and Aims Hypertension prevalence among ESRD patients range from 76% to 90%. Sodium & volume overload is among the main mechanisms. Increasing theduration of dialysis time, either by longer session hours or increased sessions, aiming at reducing the dry weight to achieve euvolemia, may be beneficial for individuals who failed to achieve target BP or ideal volume status during standard HD prescription hours.We aim to study the effect of increasing hemodialysis session time on blood pressure control. Method This observational study was conducted on 50 adult clinically stable hypertensive prevalent HD patients on thrice weekly maintenance HD. Patients with secondary causes of hypertension and Patients with decompensated medical conditions were excluded from our study.Patients were divided into 2 groups:(A) 25 patients who received longer session hemodialysis session (4.5hour) and (B) 25 patients HD who received the usual 4 hours session. Revision of antihypertensive medicatio...
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Background Diabetic kidney disease (DKD) is considered a major cause of end stage renal disease (ESRD). It has been established that controlling microalbuminuria can delay progression to ESRD. Sodium glucose co transporter 2 inhibitor... more
Background Diabetic kidney disease (DKD) is considered a major cause of end stage renal disease (ESRD). It has been established that controlling microalbuminuria can delay progression to ESRD. Sodium glucose co transporter 2 inhibitor (SGLT2 i) is a newer antidiabetic drug that has a renoprotective and antiproteinuric effect. Aim of the Study to study the effect of SGLT2 inhibitor on proteinuria in diabetic patients and compare it with classic antiproteinuric drugs. Patients and Methods we conducted a randomized interventional study, involving 60 adult patients with type 2 DM divided into 2 groups: group I were prescribed the classic antiproteinuric drugs in the form of ACE inhibitors or ARBs, aspirin and statins and group II were prescribed an additional dapagliflozin 10 mg/day. Follow up as regard changes in UACR, HbA1C, Blood pressure, body weight and e GFR was done after 6 months of treatment. Results There was statistically significant decline in UACR after 6 months of treatmen...
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Background:: Sodium glucose co-transporter 2 inhibitor (SGLT2i) is a new arment in the prevention and treatment of diabetic kidney disease with a potential effect on reducing and preventing Chronic Kidney Disease (CKD) progression.... more
Background:: Sodium glucose co-transporter 2 inhibitor (SGLT2i) is a new arment in the prevention and treatment of diabetic kidney disease with a potential effect on reducing and preventing Chronic Kidney Disease (CKD) progression. Objective:: To evaluate the effect of SGLT2 inhibitor in comparison to traditional medication in diabetic patients with microalbuminuria. Methods: A total of 60 diabetic patients with microalbuminuria were divided into group I, where 30 patients were treated by traditional medications (RAAS blockers) and group II where 30 patients were treated by Dapagliflozin added to the traditional medications. All patients were followed up for 6 months and their Urine Albumin/Creatinine Ratio (UACR) and eGFR changes were monitered. Results:: UACR significantly declined after 6 months of treatment in group II with a p-value <0.001. There were no significant eGFR changes between both groups. Systolic blood pressure decreases in both groups, but the decrease was highl...
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Background and Aims anti-oxidants may decrease the risk of cardiovascular complications (CVC) in HD patients. We aimed to study antioxidant effect of Alpha lipoic acid and selenium on oxidative stress, endothelial repair, and... more
Background and Aims anti-oxidants may decrease the risk of cardiovascular complications (CVC) in HD patients. We aimed to study antioxidant effect of Alpha lipoic acid and selenium on oxidative stress, endothelial repair, and mitochondrial functions in HD patients by evaluating the serum level of reactive oxygen species (ROS), miRNA-126, and CoQ10. Method 60 individuals were enrolled and randomized into 3 groups, G1; 22 HD patients as control, G2; 20 HD patients received Selenium, and G3;18 HD patients received. Serum levels of ROS, CoQ10, and miRNA-126 were assessed at base line and after three months treatment for all patients. Results At baseline, all groups were matched regarding their demographic data and target parameters. After three months, in G1; the serum level of ROS increased significantly (P < 0.05), CoQ10 didn't change significantly (P > 0.05), while the fold expression of miRNA-126 decreased significantly (P < 0.05). In G2,3; there were statistical signif...
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Introduction and Aims Patients on hemodialysis (HD) using dialysis catheters have significantly higher rates of morbidity and mortality which has been associated with chronic inflammatory state. In Egypt 6.6% of HD patients use catheters,... more
Introduction and Aims Patients on hemodialysis (HD) using dialysis catheters have significantly higher rates of morbidity and mortality which has been associated with chronic inflammatory state. In Egypt 6.6% of HD patients use catheters, of which short term catheters represent 59.6% and 40.4% with long-term catheters. In this study we aim to assess the possible effect of using Taurolidine citrate and unfractionated heparin (Taurolock-hep500™) in comparison to unfractionated heparin, as a lock solution for temporary hemodialysis catheters, on inflammatory status in HD patients. Methods a randomized controlled clinical trial that included 60 stable HD patients recruited from Ain Shams University hospitals at the time of catheter insertion. They were divided into two groups, Group 1: 30 Patients received taurolidine and citrate (4%) and 500 i.u of heparin as a catheter lock solution after hemodialysis sessions, Group 2: 30 patients received unfractionated heparin (5000i.u) as a cathet...
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Introduction: Hypertension prevalence among end-stage renal disease (ESRD) patients range from 76% to 90%. Increasing the duration of dialysis time, either by longer session hours or increased sessions, aiming at reducing the dry weight... more
Introduction: Hypertension prevalence among end-stage renal disease (ESRD) patients range from 76% to 90%. Increasing the duration of dialysis time, either by longer session hours or increased sessions, aiming at reducing the dry weight to achieve euvolemia, may be beneficial for individuals who failed to achieve target BP or ideal volume status during standard HD prescription hours. Objective: We aimed to study the effect of increasing hemodialysis session time on blood pressure control. Methods: This observational study was conducted on 50 hypertensive prevalent HD patients on thrice-weekly maintenance HD. Patients were divided into 2 groups: (A) 25 patients who received longer hemodialysis session (4.5 hours) and (B) 25 patients HD who received the usual 4 hours session. They were followed up for a period of 6 months to assess changes of pre-dialysis blood pressure to monitor response. Results: Ultrafiltration volume declined significantly with longer HD sessions compared to conv...
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Medicine and Hemodialysis
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Gastroenterology, Reflux, Medicine, Internal Medicine, Heartburn, and 4 moreGerd, Egyptian, Gastro, and Laryngitis
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Background Despite the fact that the fundamental characteristics of coronavirus disease-2019 (COVID-19) are respiratory manifestations, multi-organ failure including the kidney has been documented. There are no clear comparisons of... more
Background Despite the fact that the fundamental characteristics of coronavirus disease-2019 (COVID-19) are respiratory manifestations, multi-organ failure including the kidney has been documented. There are no clear comparisons of COVID-19 cases with and without acute kidney injury (AKI) to show whether there are aspects of acute kidney injury progression path or outcome that are unique to this disease. Methods In this work, we analyzed the data of 734 COVID-19 cases admitted to the Ahmad Maher Teaching Hospital in Cairo, Egypt, between June 6 and July 25, 2020. Data on demographics, comorbidities, laboratory results, and outcomes were assessed. To assess the incidence rate of AKI in Egyptian COVID-19 patients, comparisons were carried out between home-isolated COVID-19 patients, hospitalized COVID-19 patients, and ICU COVID-19-patients with or without AKI. Results AKI was more common in hospitalized mild COVID-19 patients than in home-isolated and ICU COVID-19 patients (15.0% vers...
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Renal allograft survival requires multiple immunosuppressive drugs. This strategy may lead to gastric complications that necessitate gastro‐protective medications, notably, proton pump inhibitors (PPI). This study aimed to compare the... more
Renal allograft survival requires multiple immunosuppressive drugs. This strategy may lead to gastric complications that necessitate gastro‐protective medications, notably, proton pump inhibitors (PPI). This study aimed to compare the influence of pantoprazole and esomeprazole on serum cyclosporine trough levels (C0) in renal transplant recipients (RTR). A prospective, parallel, open‐label trial was conducted on 47 adult RTR receiving cyclosporine doses adjusted to attain trough concentrations of 100 to 150 μg/L, mycophenolate mofetil (MMF) 750 mg q12 hour and prednisolone at 5 mg daily at Nasser Institute, Cairo, Egypt from January to September 2016. Patients were randomized into the esomeprazole group (25) or pantoprazole group (22) receiving the same dose (40 mg once daily). The study outcomes included clinical signs of rejection and renal function decline, assessed by elevations in serum creatinine, caused by cyclosporine level variations in either of the two study groups. Renal function, C0 and CBC measurements were measured at baseline and monthly for 6 months. The mean C0 values were higher in the pantoprazole group than in the esomeprazole group in the sixth month only (P = .007). Serum creatinine level was lower in the sixth month than at baseline in the esomeprazole group (P = .004). There were no signs of rejection biochemical or clinical in any of the study groups. In conclusion, PPIs should be used with caution and doses should be titrated to reach the C0 targets in RTR, which is of more importance in pantoprazole than esomeprazole to avoid C0 level elevation or decline affecting the allograft function.
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Hypertriglyceridemia (HTG) is a very common, yet underappreciated problem in clinical practice. Elevated triglyceride (TG) levels are independently associated with atherosclerotic cardiovascular disease (ASCVD) risk. Furthermore, severe... more
Hypertriglyceridemia (HTG) is a very common, yet underappreciated problem in clinical practice. Elevated triglyceride (TG) levels are independently associated with atherosclerotic cardiovascular disease (ASCVD) risk. Furthermore, severe HTG may lead to acute pancreatitis. Although LDL-guided statin therapy has improved ASCVD outcomes, residual risk remains. Recent trials have demonstrated that management of high TG levels, in patients already on statin therapy, reduces the rate of major vascular events. Few guidelines were issued, providing important recommendations for HTG management strategies. The goal of treatment is to reduce the risk of ASCVD and acute pancreatitis. The management stands on lifestyle modification, detection of secondary causes of HTG and pharmacological therapy, when indicated. In this guidance we review the causes and classification of HTG and summarize the current methods for risk estimation, diagnosis and treatment. The present guidance provides a focused u...
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Abstract Infections are considered as an important com-plication of uremia. The cause of immunosuppression in patients with renal failure is not exactly localized. Defect in the mononuclear cells with disturbance related to adenosine... more
Abstract Infections are considered as an important com-plication of uremia. The cause of immunosuppression in patients with renal failure is not exactly localized. Defect in the mononuclear cells with disturbance related to adenosine metabolism was presumed to be an important contributor to immune ...
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Background: Anemia is a common complication in patients on chronic hemodialysis.Functional iron deficiency is a state in which insufficient iron is released from the reticuloendothelial system with failure of iron utilization and... more
Background: Anemia is a common complication in patients on chronic hemodialysis.Functional iron deficiency is a state in which insufficient iron is released from the reticuloendothelial system with failure of iron utilization and ineffective erythropoiesis. Vitamin C, or ascorbic acid, increases the release of iron from ferritin and the reticuloendothelial system, enhances iron utilization during heme synthesis, and has antioxidant properties improving sensitivity to rEPO. So, we aimed to study the effect of short term low dose treatment with intravenous ascorbic acid on iron homeostasis in cases of functional iron deficiency in chronic renal failure patients on regular hemodialysis. Material and methods: Sixty anemic patients with functional iron deficiency on regular hemodialysis were chosen and randomly divided into 2 groups. Group I: 30 patients received erythropoietin and iron therapy plus a dose of 300mg of IVAA /session for 2 months. Group II: 30 patients received erythropoie...
Background Diabetes mellitus (DM) is the most frequent cause of chronic kidney failure in both developed and developing countries. Diabetic nephropathy, is a clinical syndrome characterized by albuminuria (>300 mg/day) with permanent... more
Background Diabetes mellitus (DM) is the most frequent cause of chronic kidney failure in both developed and developing countries. Diabetic nephropathy, is a clinical syndrome characterized by albuminuria (>300 mg/day) with permanent and irreversible decrease in glomerular filtration rate (GFR). Aim of the Work To study the role of urinary TNF-α and urine KIM-1 in type 2 diabetic patients as predictors of DN comparative with albuminuria. Patients and Methods This is a cross-sectional study which include 90 type-2 diabetic patients and 30 controls selected from the outpatient clinic of Assiut University hospitals. All patients gave an informed consent and approval for the study was obtained from the IRB committee of the Assiut Medical Faculty. The recruited patients were divided into three groups: Normo-albuminuria Group (A) (n = 30): UACR less than 30 mg/gm, Microalbuminuria Group (B) (n = 30): UACR between 30-299 mg/gm and Macro-albuminuria Group (C) (n = 30): UACR equal or more...
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MicroRNA (miRNA) 499 is an evolutionarily conserved muscle-specific miRNA that is encoded by an intron of the myh7 gene and is likely to play a role in myosin gene regulation. It has been shown to be involved in inhibiting apoptosis and... more
MicroRNA (miRNA) 499 is an evolutionarily conserved muscle-specific miRNA that is encoded by an intron of the myh7 gene and is likely to play a role in myosin gene regulation. It has been shown to be involved in inhibiting apoptosis and myocardial infarction induced by ischemia and anoxia. It is unknown whether levels of miRNAs are affected in patients undergoing hemodialysis. The aim of this study was to assess circulating levels of miRNA 499 in hemodialysis patients and whether the levels are affected by dialyzer membranes (high flux vs. low flux). The studied population consisted of 32 end stage renal disease (ESRD) patients (22 males and 10 females) with age ranged from 38% to 75% years on regular hemodialysis (4 hours, 3 times weekly) for at least 1 year duration with cardiovascular events in the last 6 months and 32 healthy controls (20 males and 12 females) with an age range from 54 to 60 years. Patients were involved into a two-stage sequential study; high-flux hemodialysis ...
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This study among elderly renal Egyptian patients (n=220) with only 20 of them were subjected to renal biopsy. Results showed: diabetic nephropathy in 28.2%, hypertensive nephrosclerosis 25.5%, UTI, cystitis and pyelonephritis in 6.8%,... more
This study among elderly renal Egyptian patients (n=220) with only 20 of them were subjected to renal biopsy. Results showed: diabetic nephropathy in 28.2%, hypertensive nephrosclerosis 25.5%, UTI, cystitis and pyelonephritis in 6.8%, renal stones in 5.9%, obstructive uropathy in 7.6%, simple cysts in 4.5%, CRF of unknown origin in 13.1%, and others in 26.4%. DM and HTN were S related to kidney function tests and increase in elderly. Other cardiovascular risk factors and smoking are reported by previous workers to be HS related to renal diseases. Age was significantly related to GFR, BUN and Cr. but sex difference was not significantly related to renal diseases. Multiple myeloma, lupus nephritis, vasculitis and hepatitis B were all recorded in few numbers of elderly Egyptians. HCV was more common and more likely to cause renal diseases. Abdomino-pelvic ultrasound was confirmatory to clinical renal diseases diagnosis. Among patients (n=20) biopsies showed focal necrotizing GN in 20%,...
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Background Numerous epidemiological investigations and randomized clinical studies have determined that dyslipidemia is a major contributor to atherosclerotic cardiovascular disease (ASCVD). Consequently, the management of serum... more
Background Numerous epidemiological investigations and randomized clinical studies have determined that dyslipidemia is a major contributor to atherosclerotic cardiovascular disease (ASCVD). Consequently, the management of serum cholesterol and low-density lipoprotein levels has become a central objective in the effort to prevent cardiovascular events. Main body Many guidelines were issued by different organizations and societies to define patient risk and establish important recommendations for management strategies. Newer cholesterol-lowering agents (non-statin drugs) are described, and their use is directed primarily to secondary prevention in patients at very high risk of new ASCVD. Conclusion The present guidance summarizes the current methods for risk estimation and outlines the most recent data on lipid management in a simple user-friendly format, to improve physician awareness and help implement guidelines in the daily practice.