Chronic Renal Failure Patients Research Articles

Melittin induces autophagy to alleviate chronic renal failure in 5/6-nephrectomized rats and angiotensin II-induced damage in podocytes.

Chronic renal failure (CRF) is a complex pathological condition that lacks a cure. Certain Chinese medicines, such as melittin, a major component in bee venom, have shown efficacy in treating CRF patients. On the other hand, the mechanisms underlying the therapeutic effects of melittin are unclear. A 5/6 nephrectomy model (5/6 Nx) of renal failure was established on rats for in vivo assays, and mouse podocyte clone 5 (MPC5) mouse podocyte cells were treated with angiotensin II (AngII) to establish an in vitro podocyte damage model. The 24-h urine protein, serum creatinine, and blood urea nitrogen levels were evaluated after one, 2, and 4 weeks. Hematoxylin and eosin staining, Masson staining, and periodic acid-Schiff staining were used to examine the pathological changes in kidney tissues. A cell counting kit 8 assay was used to assess the cell viability. Reverse transcription polymerase chain reaction and Western blot were used to assess the mRNA and protein levels in the cells, respectively. In the rat 5/6 Nx, melittin reduced the 24-h urinary protein excretion and the serum creatinine and blood urea nitrogen levels. Furthermore, the renal pathology was improved in the melittin-treated 5/6 Nx rats. Melittin promoted podocin, nephrin, Beclin 1, and the LC3II/LC3I ratio and inhibited phosphorylated mammalian target of rapamycin (mTOR)/mTOR in 5/6 Nx-induced rats and AngII-induced MPC5 mouse podocyte cells. Moreover, inhibiting autophagy with 3-MA weakened the effects of melittin on podocin, nephrin, and the LC3II/LC3I ratio in podocytes. Melittin may offer protection against kidney injury, probably by regulating podocyte autophagy. These results provide the theoretical basis for applying melittin in CRF therapy.

Determinant and Impact of Left Ventricular Hypertrophy (LVH) in Chronic Renal Failure (CRF) Patients

Left ventricular hypertrophy is the most common cardiovascular complication in chronic renal failure. It appears to be associated with excess mortality. Objective: To determine the factors associated with left ventricular hypertrophy (LVH) in patients with chronic kidney disease (CKD), and to describe their influence on renal function. Patients and methods: This was a descriptive and analytical study conducted over 6 years (January 1, 2012 to December 31, 2017) on CKD patients who had an electrocardiogram or cardiac ultrasound. Results: A total of 329 patients were included. LVH was found in 223 patients, a prevalence of 68%. The sex ratio M/F was 2.1. Mean age was 51.05±14.17 years (range 11-95 years). Arterial hypertension predominated (97% of cases), followed by diabetes (26%).Univariate and multivariate analysis showed that LVH was associated with: age ≤51 years (p=0.0037) and with arterial hypertension (p=0.0018) and anemia (p=0.0018). Over a 5-year period, CKD patients with LVH experienced a more rapid decline in renal function than those without LVH (p<0.0001). There was also a higher rate of death in patients with LVH (83%) than in those without (46%) during a 5-year follow-up. Conclusion: LVH is an important factor in the poor prognosis of CKD. This calls for systematic screening and early management by a multidisciplinary team.

Association of Gender, Age, Physiological, and Biochemical Parameters among Chronic Renal Failure Patients at Zawia Kidney Hospital

Background and objectives. Chronic renal failure is a major problem and one of the main causes of morbidity and mortality in the world. kidneys maintain internal balance of water, salts and minerals by eliminating waste products from the body. This study conducted to evaluate the association of physiological and biochemical changes among patients with renal failure who undergo dialysis compared to healthy people. Also, to identify the incidence of CKD in males and females. Methods. This study was conducted from January 2020 to December 2020 at Zawia Kidney Hospital. It was including 114 patients with chronic renal failure and 75 healthy people. The biochemical variables which were examined in the blood serum include glucose, triglycerides and cholesterol, urea, creatinine, and electrolytes in patients with renal failure as well as the healthy people. Results. This study showed that patients aged over 31year had higher frequency of kidney failure. There was a statistically significant difference in the glucose levels between the patient’s group and the control group (p < 0.001) with patients having higher average glucose levels compared to the control group. There were no statistically significant differences between the two groups in cholesterol levels (p˂0.904). However, there was a statistically significant difference in triglyceride levels between patients and controls (p-value =0.021) as patients having higher levels compared to the control group. Statistically significant differences observed in urea, creatinine, calcium, sodium, potassium and phosphate values among renal failure and control groups as (p˂0.001 for each). In the relationship between blood type patients and kidney disease, the results showed a significant association between blood type and kidney failure (p<0.001). Also, our study revealed that there is a significant correlation between gender and chronic renal failure (p<0.001). In addition, an odds ratio of 11.7 indicates that the odds of men developing kidney failure are 11.7 times higher than that of women. Conclusion. Older ages, male, and O blood group are risk factors for chronic renal failure. Clear difference in the level of biochemical parameters in chronic renal failure compared to healthy people.

Changes of FGF23 and hearing in chronic renal failure and their correlation analysis

BackgroundTo explore the association between fibroblast growth factor 23 (FGF23) and hearing in chronic renal failure (CRF). MethodsPure tone audiometry was used to detect the hearing of patients with CRF; the level of serum FGF23, creatinine, blood urea nitrogen (BUN), parathyroid hormone (PTH), and mean binaural hearing threshold were compared to the control group (people without kidney disease). The rat model of renal failure was established by 5/6 nephrectomy, and the auditory brainstem response (ABR) of rats after modeling was detected by the Tucker Davis Technologies (TDT) system; the expression level of FGF23 in the peripheral blood, renal and cochlear tissue was also detected. ResultsThe incidence of hearing loss (HL) and serum FGF23 were higher in CRF patients than the control group; the sFGF23 was positively correlated with the mean binaural hearing threshold. Animal studies showed that the ABR threshold, creatinine, FGF23, BUN, and PTH increased after modeling; although, an increase in FGF23 was observed earlier than other indicators. The HL of rats with renal failure was significantly correlated with BUN, phosphate, PTH, sFGF23, kFGF23/β-actin, eFGF23/β-actin, weight, and modeling cycle. ConclusionsBoth CRF patients and rat models showed high-frequency HL. FGF23 was highly expressed in the serum of HL renal failure patients and rats, as well as in the renal tissue and cochlea of renal failure rats. Therefore, FGF23 may be involved in the occurrence and development of HL caused by CRF.

Oral Changes in Chronic Renal Failure Patients in One of the Regional Hospitals in Kosovo

Oral Changes in Chronic Renal Failure Patients in One of the Regional Hospitals in Kosovo

Evaluation of Some Parameters to Detection of Type 2 Diabetes Induced Nephropathy in the Population Sample of Al Dewaniyah Province

Background: Diabetic nephropathy (DN is a dreaded consequence of Type2 diabetes mellitus (T2D), accounting for about 40% of end-stage renal disease (ESRD). Aim: finding a predictive and tracking function of kidney failure and generalizing it as a clinical diagnostic method effective, and finding related to the development of complications of this disease with age, gender, familiar History, smoking and area of residence. Subjects: Study was conducted at a single center in Iraq from the beginning of February to the end of July 2021,The 90 individual were divided into 2 groups, of which 50 were chronic renal failure patients with T2D, and 40 were age and sex matched controls.Methods: The Insulin and HbA1C% levels was measured by using sandwich ELISA technique and a sandwich immune detection method respectively, A spectrophotometric method was applied to measure concentrations of urea, creatinine and glucose, in serum samples, then the urea-creatinine ratio and HOMA-IR were calculated mathematically. Results: There were significant elevated differences (p<0.05) for all parameters in the patient group compared to healthy controls. Moreover, ANOVA test showed significant (p<0.05) variation when Urea, Creatinine, Glucose, HOMA-IR and HbA1C % levels were compared between the same sex in the two subgroups, while the test showed significant (p<0.05) variation for only males when Urea: Creatinine ratio and Insulin levels were compared between the same sex. Conclusion: It can be dependable on investigations of Urea, Creatinine, Urea: Creatinine ratio Glucose, Insulin, HOMA-IR and HbA1C % as good prognostic indicators for diagnosis renal failure resulting from complications of DM.

Association between intestinal microflora and renal function in patients with chronic renal failure: A case-control analysis.

To identify the association between the changes in intestinal microflora and renal function in patients with chronic renal failure (CRF). This retrospective case-control study included 50 patients with CRF (study group), admitted to the Clinical Laboratory Department of Shenzhen People's Hospital from March 2021 to May 2022, and 50 healthy individuals (control group). The association between the distribution of intestinal microflora and the glomerular filtration rate (GFR), levels of serum creatinine (SCr), blood urea nitrogen (BUN), and serum cystatin C (CysC) were analyzed. Intestinal microflora of CRF patients had significantly higher levels of Enterococci compared to the control group (p-Value <0.05), while the levels of Bifidobacterium spp. and Escherichia coli were lower in the study group (p-Value <0.05). GFR was lower, and the levels of BUN, SCr, and CysC were higher in the study group compared to the control group (all p-Value <0.05). GFR, BUN, SCr and CysC levels in the study group negatively correlated with the levels of Bifidobacterium spp. and Lactobacillus spp. (r<0, P<0.05), and positively correlated with the abundance of Enterococcus spp. and Escherichia coli (r>0, P<0.05) in the intestinal microflora. Changes in intestinal microbiota are associated with a significant decrease in GFR and a marked increase in serum levels of renal function indicators, and alterations in the balance of intestinal microbiota may lead to further aggravation of the renal function damage in patients with CRF.

Restless legs syndrome in chronic renal failure patients on dialysis.

Restless legs syndrome (RLS) occurs in patients with chronic renal failure (CRF). To determine the prevalence and morbidity of RLS in CRF patients on dialysis. This cross-sectional questionnaire-based study included 100 dialysis patients (50 on haemodialysis [HD]; 50 on peritoneal dialysis [PD]). A focused lower limb examination was done. Patients were classified with RLS when reporting uncomfortable feelings in their legs that improved with movement and worsened when resting and at night. Gender distribution was equal. The median age was 43 (19-67) years. Six patients (HD and PD n=3 each) had international criteria-confirmed RLS. Twenty-four patients reported symptoms suggestive of RLS. Fourteen and 16 patients with RLS symptoms were on HD and PD, respectively. Sleep disturbances occurred in 43.3% (n=13) of patients with RLS symptoms, compared to 20.0% (n=20) of the large cohort. Sleep disturbances, peripheral sensory loss, chronic disease-related anaemia, increased urea and decreased albumin levels were more common among patients with RLS symptoms. RLS symptoms occurred in 30.0% of the entire cohort, although only 6.0% met the international criteria. The type of dialysis had no impact on the incidence of symptoms. Identifying RLS in patients with CRF on dialysis will allow for early intervention.

Biochemical Assessment of Iron, Creatinine and Urea in Patients with Chronic kidney Failure Undergoing Hemodialysis in Relation to Anemia

Chronic renal failure (CRF) is the most prevalent worldwide public health problem affectingthe elderly population. The main cause of CRF is a damaged kidney. Dialysis cannot completelyperform lost kidney function, but to some extent, it manages its activities by means of diffusion andultrafiltration. In this study, 29 patients were recruited; 17 males and 12 females undergoinghemodialysis. After taking information from the patients through a questionnaire, the following resultswere obtained; The CRF in patients who have overweight body mass index (BMI) were the highestpercentage. The patients were divided into three groups based on their duration for hemodialysis(≤1year, 2years, ≥years) for evaluating complete blood count parameters: Total RBC, Total WBC, Hb,Hct, MCV, MCH, MCHC and RDW. There were no significant differences between them. Forbiochemical parameters, blood sugar was significantly higher in patients with a duration ofhemodialysis ≤1year when compared with ≥3years. At the same time, blood sugar was significantlyhigher in patients with a duration of hemodialysis of two years when compared with ≥3years. Serumiron, S.creatinine and S.urea: no significant differences were observed during comparison of the threegroups. A statistically significant correlation was found between systolic blood pressure and hematocrit(p≤0.05). At the same time, a significant correlation was found between diastolic blood pressure andtotal platelets count (p≤0.05), while other test results were not statistically significant (p&gt;0.05).

SEROPREVALENCE DE LA TOXOPLASMOSE A DAKAR : ÉTUDE COMPARATIVE ENTRE LES DONNEURS DE SANG ET LES PATIENTS ATTEINT D’INSUFFISANCE RENALE CHRONIQUE

SummaryIntroduction: Toxoplasmosis infection is not transmitted from human to human, except in the case of transmission from mother to fetus, blood transfusion, or transplantation of an infected organ. The aim of this study was to compare the seroprevalence of toxoplasmosis in blood donors and patients with chronic renal failure (CRF) treated at the Ouakam Military Hospital (HMO). Methodology: We conducted a cross-sectional study between September and December 2022 among CRF patients followed up at the HMO and blood donors. A questionnaire was administered to collect socio-demographic information. A blood sample was then taken. Toxoplasma gondii IgG and IgM antibodies were tested by chemiluminescence. Data were analyzed using Epi Info 7.2.5.0 software. Results: A total of 200 participants were enrolled, including 100 volunteer blood donors and 100 hemodialysis patients. The mean ages were 30.7 ± 10 years and 41.4 ± 14.6 years for blood donors and CRF patients respectively. The overall seroprevalence of toxoplasmosis in blood donors was 33%, whereas it was 38% in CRF patients. IgM antibody positivity was noted in only one patient. Seroprevalence of toxoplasmosis in blood donors was highest in the 31-44 age group, at 37.5%, while in CRF patients it was highest in the over-45 age group, at 45.2%. According to the notion of contact with a cat, it was higher in hemodialysis patients who had been in contact with a cat, with a rate of 57.9% (p=0.047), in contrast to blood donors, where the highest rate was recorded in subjects who had not been in contact with a cat. Conclusion: This study revealed that the seroprevalence of toxoplasmosis was higher in CRF patients than in blood donors, with a seroprevalence rate higher than those previously reported in Dakar in pregnant women. Keywords: Toxoplasmosis, blood donors, chronic renal failure, Dakar

Evaluation of Supervised Machine Learning Algorithms and Computational Structural Validation of Single Nucleotide Polymorphisms Related to Acute Liver Injury with Paracetamol.

To identify single nucleotide polymorphisms (SNPs) of paracetamol-metabolizing enzymes that can predict acute liver injury. Paracetamol is a commonly administered analgesic/antipyretic in critically ill and chronic renal failure patients and several SNPs influence the therapeutic and toxic effects. To evaluate the role of machine learning algorithms (MLAs) and bioinformatics tools to delineate the predictor SNPs as well as to understand their molecular dynamics. A cross-sectional study was undertaken by recruiting critically ill patients with chronic renal failure and administering intravenous paracetamol as a standard of care. Serum concentrations of paracetamol and the principal metabolites were estimated. Following SNPs were evaluated: CYP2E1*2, CYP2E1_-1295G>C, CYP2D6*10, CYP3A4*1B, CYP3A4*2, CYP1A2*1K, CYP1A2*6, CYP3A4*3, and CYP3A5*7. MLAs were used to identify the predictor genetic variable for acute liver failure. Bioinformatics tools such as Predict SNP2 and molecular docking (MD) were undertaken to evaluate the impact of the above SNPs with binding affinity to paracetamol. CYP2E1*2 and CYP1A2*1C genotypes were identified by MLAs to significantly predict hepatotoxicity. The predictSNP2 revealed that CYP1A2*3 was highly deleterious in all the tools. MD revealed binding energy of -5.5 Kcal/mol, -6.9 Kcal/mol, and -6.8 Kcal/mol for CYP1A2, CYP1A2*3, and CYP1A2*6 against paracetamol. MD simulations revealed that CYP1A2*3 and CYP1A2*6 missense variants in CYP1A2 affect the binding ability with paracetamol. In-silico techniques found that CYP1A2*2 and CYP1A2*6 are highly harmful. MD simulations revealed CYP3A4*2 (A>G) had decreased binding energy with paracetamol than CYP3A4, and CYP3A4*2(A>T) and CYP3A4*3 both have greater binding energy with paracetamol. Polymorphisms in CYP2E1, CYP1A2, CYP3A4, and CYP3A5 significantly influence paracetamol's clinical outcomes or binding affinity. Robust clinical studies are needed to identify these polymorphisms' clinical impact on the pharmacokinetics or pharmacodynamics of paracetamol.

Evaluation of Right Ventricular Function in Chronic Renal Failure Patients on Regular Hemodialysis Therapy (Tissue Doppler Imaging Study)

Evaluation of Right Ventricular Function in Chronic Renal Failure Patients on Regular Hemodialysis Therapy (Tissue Doppler Imaging Study)

A Randomized Comparative Evaluation Of Effects Of Dexmedetomidine As An Adjuvant With Bupivacainein Supraclavicular Block In Crf Patients Undergoing Basilic Vein Transposition Surgery

Aim: To compare analysis of bupivacaine in supraclavicular block with dexmedetomidine bupivacaine in supraclavicular block in chronic renal failure patients undergoing basilica vein transposition surgery. Methodology: Double-blind randomised control trial. Department of Anaesthesia, Sindh Institute of Urology and Transplantation, Karachi, from September 1st, 2021, to February 28th, 2022 Seventy chronic renal failure patients undergoing elective basilic vein transposition surgery were enrolled. Patients were divided into two groups, in which 35 patients in group A received bupivacaine (0.25%) in 28mL plus dexmedetomidine (1ug/kg) diluted to 2 mL, and 35 patients in group B were injected with bupivacaine (0.25%) in 28 mL plus 2mL of normal saline. Results: The mean time of onset of sensory blockade was comparatively higher in group B as compared to group A. Similarly, the onset of motor block time was also higher in group B as compared to group A, and the duration of motor block did not show any significant results between groups, and the duration of motor block was not statistically significant between groups [p = 0.404]. Conclusion: The combination of bupivacaine and dexmedetomidine appeared to be useful for onset time and prolongs the duration of analgesia in supraclavicular brachial plexus block. Keywords: Chronic kidney disease, Dexmedetomidine, Supraclavicular brachial plexus block

Hypnotherapy Intervention on Pain Scale Level of Arteriovenous Fistula Cannulation in Haemodialysis Patients with Chronic Renal Failure

This study aims to determine the effectiveness of hypnotherapy intervention on the level of pain scale of arteriovenous fistula cannulation installation in haemodialysis patients with chronic renal failure. This research method is quasi experimental (one pre-post group desaign). The sample of this study was chronic renal failure patients in arteriovenous fistula cannulation access insertion totalling 45 respondents using total sampling technique. The results obtained before hypnotherapy were 11 respondents (24.4%) experienced a mild pain scale level response, 34 people (75.66%) experienced a moderate pain scale level response while after hypnotherapy intervention showed all 45 respondents (100%) with a mild pain scale with a P value of 0.000 (α &lt;0.05). In conclusion, hypnotherapy intervention can significantly reduce or eliminate pain during arteriovenous fistula cannulation in haemodialysis

Nail Whispers Revealing Dermatological and Systemic Secrets: An Analysis of Nail Disorders Associated With Diverse Dermatological and Systemic Conditions.

Background and objective Nail disorders encompass a wide spectrum of conditions, spanning congenital, developmental, infectious, neoplastic, degenerative, dermatological, and systemic diseases. A comprehensive exploration of their clinical manifestations, incidence, and associations is crucial for precise diagnosis and effective management. Methods This observational cross-sectionalstudyconducted atB.J. Medical College and Civil Hospital,Ahmedabad involved 300 consecutive patients with nail changesfrom July 2017 to June 2019 reporting diverse dermatological and systemic conditions. The inclusion criteria involved patients of both genders and all age groups displaying nail changes associated with dermatological and systemic diseases. Data collection entailed a comprehensive clinical history, systemic and dermatological examinations, nail assessment using Dermoscope (DermLite 3, 10x), and supplementary tests. Analyses were performed on Microsoft Excel 2007 software. The studywas approved by the Institute Ethics Committee. Results Among the300 cases, females had a higher prevalence of nail involvement (57%), with a female-to-male ratio of 1.3:1. The most affected age group was 21-40 years, with 6-10 nails typically affected. Notably, housewives showed a higher prevalence. The most frequent nail condition was onychomycosis (24.33%) followed by psoriatic nail changes (20%).Less frequent nail changes involved eczema (5.7%), paronychia (5%), drug-induced (4.3%), lichen planus (3.7%), trauma-induced (3%), twenty nail dystrophy (2.33%), Darier's disease (2%), pemphigus vulgaris (2%), alopecia areata (1.67%), median Heller dystrophy (1.33%), atopic dermatitis (1%), epidermolysis bullosa (1%), racquet nail (1%), leprosy (1%), pityriasis rubra pilaris (0.67%), vitiligo (0.67%), secondary syphilis (0.67%), pachyonychia congenita (0.67%), as well as a case each of total leukonychia, subungual warts, Koenentumor, and periungual fibroma(0.33%). Systemic autoimmune connective tissue disorders (CTD) accounted for 9%; the most common nail finding observed was nail fold erythema (48.1%) followed by nail fold telangiectasis (44.4%). In systemic sclerosis (SS), the most common finding was nail fold telangiectasia, and in systemic lupus erythematosus (SLE), the most common was nail fold erythema. Scleroderma capillary pattern on nail fold capillaroscopy was found in seven patients with SS, two patients with dermatomyositis, and only one patientwith SLE. Nail changes observed in systemic diseasesinclude onychomycosisin diabetes mellitus and chronic renal failure patients, splinter hemorrhagesin ischemic heart disease and hypertension, longitudinal melanonychia in HIV,and koilonychia and platynychia in iron deficiency anemia.Other systemic diseases, such asAddison's disease and renal failure, also exhibited various nail changes. Conclusions Beyond their cosmetic importance, nails hold a vital pathologic role. Proficiency in nail terminology and classification is key for skillful evaluation. Understanding normal and abnormal nail variants, along with their disease associations, benefits diagnosis and tailored management. Nails, often overlooked but accessible, serve as a window into patients' general health and should be an integral part of thorough examinations.This study highlights an intricate clinical panorama of nail disorders, highlighting their significant role in both dermatological and systemic contexts.

Indoleamine 2,3-dioxygenase level and oxidative stress parameters in the serum of patients with chronic renal failure

Indoleamine 2,3-dioxygenase (IDO) is a tryptophan-degrading enzyme belonging to the kynurenine pathway. IDO activity has been suggested as a biomarker for diagnosis of chronic kidney disease. The aim of the study was to estimate the level of IDO, urea, creatinine, uric acid, phosphate, calcium, albumin, MDA, GSH, and activity of peroxidase, catalase, arylesterase in the serum of chronic renal failure (CRF) patients treated with dialysis compared to the healthy control group. The results showed a significant increment in IDO level in patients compared with the control. Linear regression analysis using the Pearson correlation coefficient showed that increased IDO level correlates positively with urea, creatinine, uric acid, phosphate, MDA level and peroxidase activity whereas negatively with albumin, calcium, glutathione level, catalase activity and glomerular filtration rate. We concluded that IDO level might be a possible marker of oxidative stress and inflammation in patients with CRF. Keywords: 3-dioxygenase, biochemical parameters, correlation analysis, indoleamine 2, renal failure, serum

Oral Manifestations of Chronic Renal Failure Patients on Hemodialysis

Kidney disease is a worldwide health problem with increasing incidence and prevalence of disease, high cost, and poor prognosis. Chronic Kidney Disease involves an irreversible loss of renal function which leads to a change in the electrolyte balance of the human body. This can lead to a large plethora of oral manifestations. A wide range of lesions may be observed in chronic renal failure patients like gingival hyperplasia, enamel hypoplasia, petechiae, gingival bleeding, and various other lesions. As literature indicates that the incidence of these pathologies are increasing, identification and providing appropriate dental care to these patients can be imperative.&#x0D; Aims: To assess the oral manifestations of chronic renal failure patients on hemodialysis.&#x0D; Methods and Materials: The oral cavity of the patients was examined for features like uremic odour, coated tongue, ulcerations, pigmentation, petechiae, ecchymosis, uremic stomatitis, xerostomia and recorded accordingly.&#x0D; Statistical Analysis Used: All the findings were tabulated and were subjected to statistical analysis using Chi square test.&#x0D; Results: A wide range of oral signs, symptoms, and lesions that include uremic odor(36.6%), xerostomia(58.3%), uremic stomatitis(5%), altered taste sensation(46.6%), coated tongue(1%), burning sensation(40%), ulceration/pigmentation(6.6%), candidiasis(5%), pale mucosa(13.3%), gingival enlargement (6.6%) and petechiae/ecchymosis(5%) were observed. Xerostomia was found to be the most common finding in 35(58.3%) patients affecting 20 (57.1%) of males and 15(42.8%) of females followed by altered taste sensation in 28 (46.6%) patients that showed an equal gender predilection.&#x0D; Conclusions: Dental considerations of renal failure patients is of utmost importance as they present with a wide range of oral manifestations. It is the Oral Physicians responsibility to treat the oral manifestations along with rendering the appropriate dental therapy to the renal failure patients.

Vascular wall microenvironment: exosomes secreted by adventitial fibroblasts induced vascular calcification

Vascular calcification often occurs in patients with chronic renal failure (CRF), which significantly increases the incidence of cardiovascular events in CRF patients. Our previous studies identified the crosstalk between the endothelial cells (ECs) and vascular smooth muscle cells (VSMCs), and the paracrine effect of VSMCs, which regulate the calcification of VSMCs. Herein, we aim to investigate the effects of exosomes secreted by high phosphorus (HPi) -induced adventitial fibroblasts (AFs) on the calcification of VSMCs and the underlying mechanism, which will further elucidate the important role of AFs in high phosphorus vascular wall microenvironment. The conditioned medium of HPi-induced AFs promotes the calcification of VSMCs, which is partially abrogated by GW4869, a blocker of exosomes biogenesis or release. Exosomes secreted by high phosphorus-induced AFs (AFsHPi-Exos) show similar effects on VSMCs. miR-21-5p is enriched in AFsHPi-Exos, and miR-21-5p enhances osteoblast-like differentiation of VSMCs by downregulating cysteine-rich motor neuron 1 (Crim1) expression. AFsHPi-Exos and exosomes secreted by AFs with overexpression of miR-21-5p (AFsmiR21M-Exos) significantly accelerate vascular calcification in CRF mice. In general, AFsHPi-Exos promote the calcification of VSMCs and vascular calcification by delivering miR-21-5p to VSMCs and subsequently inhibiting the expression of Crim1. Combined with our previous studies, the present experiment supports the theory of vascular wall microenvironment.Graphical

Efficacy and Safety of Different Modalities for Treatment of Erectile Dysfunction in Chronic Renal Failure Patients

Background Erectile dysfunction has been found to be significantly more common in men with chronic kidney disease (CKD) than in the general population. Objective of the Study Detection of the safest and most effective medical treatment of erectile dysfunction(ED) in chronic renal failure patients. Patients and Methods . This study was conducted at Ain Shams University Hospitals with a sample size of 60 patients: 15 patients per group. We assessed the improvement in the erectile function through assessment of IIEF (International Index of Erectile Function) score and EHS (Erection Hardness Scale) score pre- and post-administration of the drugs used in the study (oral sildenafil, oral vardenafil, oral tadalafil and intracavernosal injection of alprostadil). Results There is a statistically significant increase in IIEF score post-administration of the drugs used in this study with p value of &amp;lt; 0.001 and a mean difference of 6.92. The mean score of IIEF pre-administration of the drugs used was 8.13 and post-administration was 15.05. There is also a statistically significant difference in EHS score with p value of &amp;lt; 0.001 and mean difference of 1.4. The mean score of EHS pre-administration of the drugs was 1.22 and post-administration was 2.62. From the four drugs used in this study, Alprostadil showed the highest improvement in IIEF and EHS scores. The study also showed a negative correlation between age, duration of haemodialysis and serum creatinine with erectile function. In addition, there was a statistically significant decrease in pre- and- post-treatment IIEF and EHS scores in diabetic cases than in the non-diabetic cases. Conclusion There is high incidence of ED in CKD patients. The drugs used in the study showed improvement in the erectile function with mild side effects. Alprostadil had the best IIEF and EHS scores amongst the four drugs.

Anatomical and Functional Evaluation of RNFL Parameters and Choroidal Thickness Changes in Patients with Chronic Renal Failure Undergoing Hemodialysis Using Spectral-Domain Optical Coherence Tomography and Visual Field

Background There is a structural analogy between the glomerular vascular network and the choroidal circulation. With hemodialysis (HD), lots of alterations occur in patients' homeostasis and metabolic parameters. These alterations affect the eye and may cause neuro-ophthalmologic complications. Aim To evaluate anatomical and functional changes of retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL), and changes in subfoveal choroidal thickness (SFCT) in patients with chronic renal failure (CRF) on HD. Methods This case control study was carried on 20 eyes of 20 CRF patients (HD group) and 20 eyes of 20 healthy individuals. 10 of the HD group were non-diabetic (NDM subgroup) and 10 were diabetic (DM subgroup). For all eyes, the thickness of peripapillary RNFL, GCL, and SFCT were measured by optical coherence tomography (OCT) (RS-3000; NIDEK, Japan) and visual field (VF) analysis using Humphrey field analyzer (Carl Zeiss, USA). Results A statistically significant decrease in peripapillary RNFL thickness in HD group when compared to the control group in most analyses, but did not amount to statistical significance in the temporal quadrant and in 5 of the studied clock hour sectors. There was also a statistically significant decrease in the macular GCL thickness of HD group when compared to the control group in both hemifields, and in all of the 8 subfields. The results of the SFCT reported in HD group were also significantly less than that reported in the control group. Analysis of results from VF demonstrated a highly significant depression in both MD and PSD of the HD group when compared to the control group. The difference between the NDM and DM subgroups was not significant in any of the studied parameters. Conclusion Our results demonstrate highly significant retinal and choroidal changes in CRF patients on HD. Thus, we recommend that CRF patients undergo regular ocular examination by OCT to prevent early ocular damage.