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Background: Renal resistive index (RRI) was suggested as an indicator of renal atherosclerotic changes in hypertensive patients with possible prognostic role in treatment.Objectives: This study aimed to assess RRI in hypertensive subjects, its relation to other predictors of target organ damage and prognostic usefulness in management, specifically, with different antihypertensive drugs. Patients and methods:The study included 100 newly diagnosed hypertensive adult subjects, who underwent abdominal ultrasound with Doppler to assess RRI, which was correlated with their clinical parameters including estimated glomerular filtration rate (eGFR) and other subclinical atherosclerosis markers as carotid intima-media thickness (IMT) and aortic knob width (AKW) calculated from chest radiograph. Another 50 non hypertensive subjects were assessed for their RRI as a control group. In addition, some of hypertensive patients were followed up one year after starting treatment was done and effects of different antihypertensive agents on their RRI were compared. Results:The mean baseline RRI in hypertensive patients (0.71 ± 0.04) was significantly higher compared to control group (0.60 ± 0.02) and was positively significantly correlated with their clinical parameters (age, systolic, diastolic, pulse pressure and eGFR) and with their atherosclerotic parameters (IMT and AKW). In addition, ACE/ARBs treatment was associated with significant decrease of RRI compared to other drugs [beta blocker (BB) and calcium channel blocker (CCB)], indicating their more renal protective effect. Conclusion: Assessment of RRI in patients with primary hypertension not only reflecting intrarenal perfusion changes, but it indicates systemic atherosclerotic changes, so it can be useful as prognostic parameter in addition to its possible therapeutic implications.

Background: Occult HCV infection (OCI) describes detectable viral RNA in the hepatocytes and in peripheral blood mononuclear cells (PBMCs) in the absence of conventional markers for HCV. The present study aimed to detect the prevalence of occult hepatitis C virus infection in patients who achieved a sustained virologic response (SVR) to directacting antiviral agents (DAAs) and to outline predictors of OCI. Patients and methods: This multicenter cross-sectional study included 50 males and 50 females seeking treatment for chronic hepatitis C patients without liver cirrhosis who were treated with combination of sofosbuvir (SOF) and daclatasvir (DCV) with or without ribavirin for three months and achieved SVR as proved by negative PCR after 12 weeks of the end of treatment. Twelve weeks after the end of treatment, HCV RNA was tested in PBMCs to detect OCI in patients with SVR. Logistic regression was used to find out factors affecting the presence of OCI. ROC curve was used to evaluate the performance of different tests to predict OCI. Results: Of the 100 patients, 12 (12%) had detectable HCV RNA in PBMCs after achieving SVR12 denoting presence of occult HCV infection. Age ≤45 years and male gender were significant predictors for occurrence of OCI. However, direct bilirubin ≥0.40 mg/dL was a significant predictor with low diagnostic performance. Conclusion: OCI can persist in sustained responders to DAA therapy and the risk of OCI is more prevalent in males younger than 45 years. Age and direct bilirubin can be possible predictors for OCI.

Background and aims Micro-elimination of hepatitis C in renal patients is crucial. This study aims to assess the efficacy and safety of directly acting antivirals in chronic kidney disease patients and the effect of treatment on kidney functions. Results This prospective cohort study included 77 chronic HCV-infected patients with chronic kidney disease. Patients were consented and treated for 12 weeks with either sofosbuvir and daclatasvir ± ribavirin if glomerular filtration rate was > 30 mL/min per 1.73m2 or ritonavir-boosted paritaprevir-ombitasvir-ribavirin if it was < 30 mL/min per 1.73m2. Patients were divided into two categories (responders versus non-responders). Predictors of response to treatment were statistically analyzed through logistic regression analysis. Sixty-two patients received ritonavir-boosted paritaprevir-ombitasvir-ribavirin, 3 received sofosbuvir and daclatasvir, and 12 received sofosbuvir and daclatasvir plus ribavirin. Most patients were on hemodialysis (n = 36) while 31 were stage 3 kidney disease. All patients completed their treatment course; ribavirin doses were adjusted or stopped in patients who developed anemia (40%). Seventy-two patients (93.5%) achieved sustained virological response 12 weeks following end-of-treatment. Five patients (6.5%) were non-responders, 4 of whom were on hemodialysis (p = 0.179). All non-responders were on ritonavir-boosted paritaprevir-ombitasvir-ribavirin. The mean serum creatinine level at weeks 4 and 8 of treatment demonstrated significant improvement compared to pretreatment values (p < 0.001) in patients on conservative therapy. Conclusion Treatment of chronic kidney disease patients for chronic hepatitis C with directly acting antivirals is safe, efficacious with high response rates and likely to improve renal functions if started early in the course of kidney disease.

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