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Background: There are various changes in the thyroid gland and its function in end stage renal disease (ESRD). It is not surprising that impairment of kidney function leads to disturbed thyroid physiology. Objective: Is to detect thyroid function abnormalities in hemodialysis patients. Patients and Methods: 100 patients on maintenance hemodialysis (HD) were enrolled, they were excluded if they had the following criteria: history of thyroid disease, thyroid and parathyroid surgery, under interferon therapy, exposed to radiation, antithyroid drugs or thyroid replacement therapy, and those under 30 years. They were subjected to history taking, clinical examination and laboratory investigations including hepatitis C virological state, renal functions and thyroid functions. Results: 92% of patients had normal thyroid-stimulating hormone (TSH) levels, 8% had abnormal TSH levels. Regarding fT3 levels, 67 % had normal fT3 while 33 % had abnormal fT3, and only 11 patients had abnormal fT4. In respect to the thyroid hormone status, only one was hyperthyroid, 92% were in euthyroid status, 2% were clinically hypothyroid, 5% were subclinically hypothyroid, and 1% was hyperthyroid. There was significant negative correlation between TSH levels and dialysis duration, 8 patients having abnormal thyroid functions ere females, and 60% had HCV positive status. No significant associations were found between HCV infection and the thyroid hormones levels. However, HCV positive patients experienced lower levels of T4 and TSH. Conclusion:The average percentage of patients under regular hemodialysis with abnormal thyroid state is 8% with females having abnormal fT4 and TSH levels compared to males. TSH levels were inversely correlated with dialysis duration.

BACKGROUND The prevalence of chronic kidney disease is increasing rapidly worldwide, and recent data indicate that overt disease is the tip of the iceberg of covert disease. Data on the prevalence and incidence of proteinuria in young adults are scarce. This lack of knowledge is an obstacle to the establishment of prevention programs for chronic kidney disease, especially in developing countries. SETTING AND PARTICIPANTS Urine screening for proteinuria was carried out in a cohort of young adults in a student hostel of Ain Shams University, Cairo, Egypt. Fresh morning urine samples were collected and tested for proteinuria by dipstick analysis. Participants with persistent proteinuria were referred to the university hospital for further evaluation for the presence of kidney disease. RESULTS Of 1,260 apparent healthy students screened, 67.7% were males and 32.3% were females. Their mean age was 20.2 ± 1.2 years. 3.3% were hypertensive, and proteinuria was detected in 47 (3.7%) in the first screening test. At the second screening test, persistent proteinuria was found in 10 students (0.8% of the original cohort). Of these, 4 (0.3%) had proteinuria more than 0.5 g/24 h, but all of them refused renal biopsy. CONCLUSIONS Urine dipstick is an inexpensive way to screen for proteinuria in developing countries, but it must be done twice to exclude transient and intermittent proteinuria. Routine screening for proteinuria in this particular young adult population is not recommended due to its low diagnostic yield.

Introduction. Lupus nephritis (LN) affects almost two-thirds of systemic lupus erythematosus (SLE) patients. Despite initial aggressive therapy, up to 25% of patients with LN will progress to permanent renal damage. Conventional serum markers for LN lack the sensitivity of an ideal biomarker. Urinary neutrophil gelatinase-associated lipocalin (UNGAL) is an excellent biomarker for early diagnosis of acute kidney injury and predicting renal outcomes. Objective. To measure UNGAL among LN patients to correlate its levels with renal disease activity and to investigate its predictive performance in response to induction therapy. Patients and Methods. 40 SLE patients with biopsy-proven LN class III, IV, or V were randomly selected. The study was conducted in the internal medicine department and outpatient clinic in Ain Shams University Hospitals and completed after six months. UNGAL was measured at baseline, three-month follow-up, and after complete induction therapy. Results. In LN patients at baseline, the mean serum creatinine was 2.57 ± 0.96 mg/dL and the mean UNGAL was 33.50 ± 18.34 ng/dL. Mean UNGAL levels of complete response, partial response, and nonresponse groups were 14.48 ± 2.99 ng/mL, 34.49 ± 4.09 ng/mL, and 62.07 ± 14.44 ng/mL, respectively. Based on the ROC curve, we found a better performance of baseline UNGAL to discriminate the complete response group from partial and nonresponse groups to predict response to induction, outperforming conventional biomarkers. The area under the curve was 0.943, and the best cutoff level was 26.5 ng/mL (92.31% sensitivity and 88.89% specificity). Conclusion. UNGAL performed better than conventional biomarkers in predicting response to treatment of active LN.

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