Abstract Background: Defining new predictive biomarkers in diabetic kidney disease (DKD) would provide a window of opportunity for preventive and/or therapeutic interventions to prevent or delay the onset of irreversible long-term micro and or macro vascular complications. Adiponectin (ADPN) has been variously associated with diabetic microvascular complications; however, no comprehensive clinical data exist examining the association between adipocytokines and the presence of these complications. Aim of study: we aimed to measure the plasma levels of adiponectin in patients with type 2 diabetes mellitus, to assess whether these levels vary with the different stages of DKD according to their e GFR and to evaluate its relation to their microvascular complications and glycemic control. Methods: This is a prospective observational study including 100 T2DM classified into two groups according to their albuminuria levels and estimated GFR. Participants subjected to thorough history taking and clinical examination. Serum level of ADPN was assessed in all patients. Results: Serum ADPN levels were significantly lower in T2DM patients with nephropathy (P = 0.001), while their levels were nonsignificantly higher in patients with non-proliferative retinopathy or neuropathy. Their levels were lowered with more advanced stages of DKD with nephropathy and the decrement was dependent on their severity (P0.001). Levels of ADPN with cutoff value of 22600 (μg/mL) had ability to diagnose microvascular complications in our diabetic patients with sensitivity (81%) and specificity (27%). Multivariate logistic regression analysis showed that the odds ratio for the presence of nephropathy in the lowest tertile of ADPN was 1.09 (95% CI; 11.45- 13.08, P= 0.06), therefore, ADPN was not an independent risk factor for diabetic nephropathy. However, its higher level was independently associated with increased odds for the presence of neuropathy in particular. Conclusions: ADPN plays a role in the pathogenesis of microvasculopathy in diabetic patients and help to identify high-risk patients and modulate the therapeutic potential in the revention of DKD.

Abstract Background: Defining new predictive biomarkers in diabetic kidney disease (DKD) would provide a window of opportunity for preventive and/or therapeutic interventions to prevent or delay the onset of irreversible long-term micro and or macro vascular complications. Adiponectin (ADPN) has been variously associated with diabetic microvascular complications; however, no comprehensive clinical data exist examining the association between adipocytokines and the presence of these complications. Aim of study: we aimed to measure the plasma levels of adiponectin in patients with type 2 diabetes mellitus, to assess whether these levels vary with the different stages of DKD according to their e GFR and to evaluate its relation to their microvascular complications and glycemic control. Methods: This is a prospective observational study including 100 T2DM classified into two groups according to their albuminuria levels and estimated GFR. Participants subjected to thorough history taking and clinical examination. Serum level of ADPN was assessed in all patients. Results: Serum ADPN levels were significantly lower in T2DM patients with nephropathy (P = 0.001), while their levels were nonsignificantly higher in patients with non-proliferative retinopathy or neuropathy. Their levels were lowered with more advanced stages of DKD with nephropathy and the decrement was dependent on their severity (P0.001). Levels of ADPN with cutoff value of 22600 (μg/mL) had ability to diagnose microvascular complications in our diabetic patients with sensitivity (81%) and specificity (27%). Multivariate logistic regression analysis showed that the odds ratio for the presence of nephropathy in the lowest tertile of ADPN was 1.09 (95% CI; 11.45- 13.08, P= 0.06), therefore, ADPN was not an independent risk factor for diabetic nephropathy. However, its higher level was independently associated with increased odds for the presence of neuropathy in particular. Conclusions: ADPN plays a role in the pathogenesis of microvasculopathy in diabetic patients and help to identify high-risk patients and modulate the therapeutic potential in the revention of DKD.

Introduction: Acute kidney injury is associated with increased mortality in hospitalized cirrhotic patients; therefore early and accurate diagnosis is crucial. The prognosis of AKI in cirrhosis depends on its specific aetiology which remains a challenge. Aim: We aimed to determine the accuracy of urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) for diagnosis, differentiation of the various aetiologies of AKI in cirrhotics and to evaluate its value in short term prognosis. Methods: Eighty-two cirrhotic patients were investigated for uNGAL during hospital admission and AKI types were determined blinded to uNGAL measurements. Patients were followed up till discharge. Results: Patients with liver cirrhosis and renal impairment (n= 62) had significantly higher levels of uNGAL (102.4 ±100 ng/ml) when compared with patients with cirrhotics with normal kidney function (n= 20) (102.4 ±100 vs 17.4±14.71 ng/ml). Patients with acute tubular necrosis (ATN) had significantly higher uNGAL (189.2±124 ng/ml) compared to other aetiologies, while prerenal azotemia had the lowest value (46.1±39.9 ng/ml). UNGAL levels were significantly higher in the mortality group of patients (p=0.006) and in patients admitted to ICU (p0.001) than the survivors and patient without ICU admission respectively. The AUC of uNGAL for diagnosis of AKI was 0.892 with a cutoff > 33 ng/ml providing specificity 90% and sensitivity 79%. In multivariate regression analysis, uNGAL was highly significant independent predictor of inpatient cirrhosis relayed mortality. Conclusion: UNGAL is a promising biomarker for diagnosis of AKI and differentiation between its different aetiologies in cirrhosis including ATN, HRS and pre renal azotemia. UNGAL can independently predict poor short term prognosis.

Introduction: Acute kidney injury is associated with increased mortality in hospitalized cirrhotic patients; therefore early and accurate diagnosis is crucial. The prognosis of AKI in cirrhosis depends on its specific aetiology which remains a challenge. Aim: We aimed to determine the accuracy of urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) for diagnosis, differentiation of the various aetiologies of AKI in cirrhotics and to evaluate its value in short term prognosis. Methods: Eighty-two cirrhotic patients were investigated for uNGAL during hospital admission and AKI types were determined blinded to uNGAL measurements. Patients were followed up till discharge. Results: Patients with liver cirrhosis and renal impairment (n= 62) had significantly higher levels of uNGAL (102.4 ±100 ng/ml) when compared with patients with cirrhotics with normal kidney function (n= 20) (102.4 ±100 vs 17.4±14.71 ng/ml). Patients with acute tubular necrosis (ATN) had significantly higher uNGAL (189.2±124 ng/ml) compared to other aetiologies, while prerenal azotemia had the lowest value (46.1±39.9 ng/ml). UNGAL levels were significantly higher in the mortality group of patients (p=0.006) and in patients admitted to ICU (p0.001) than the survivors and patient without ICU admission respectively. The AUC of uNGAL for diagnosis of AKI was 0.892 with a cutoff > 33 ng/ml providing specificity 90% and sensitivity 79%. In multivariate regression analysis, uNGAL was highly significant independent predictor of inpatient cirrhosis relayed mortality. Conclusion: UNGAL is a promising biomarker for diagnosis of AKI and differentiation between its different aetiologies in cirrhosis including ATN, HRS and pre renal azotemia. UNGAL can independently predict poor short term prognosis.

Introduction: Acute kidney injury is associated with increased mortality in hospitalized cirrhotic patients; therefore early and accurate diagnosis is crucial. The prognosis of AKI in cirrhosis depends on its specific aetiology which remains a challenge. Aim: We aimed to determine the accuracy of urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) for diagnosis, differentiation of the various aetiologies of AKI in cirrhotics and to evaluate its value in short term prognosis. Methods: Eighty-two cirrhotic patients were investigated for uNGAL during hospital admission and AKI types were determined blinded to uNGAL measurements. Patients were followed up till discharge. Results: Patients with liver cirrhosis and renal impairment (n= 62) had significantly higher levels of uNGAL (102.4 ±100 ng/ml) when compared with patients with cirrhotics with normal kidney function (n= 20) (102.4 ±100 vs 17.4±14.71 ng/ml). Patients with acute tubular necrosis (ATN) had significantly higher uNGAL (189.2±124 ng/ml) compared to other aetiologies, while prerenal azotemia had the lowest value (46.1±39.9 ng/ml). UNGAL levels were significantly higher in the mortality group of patients (p=0.006) and in patients admitted to ICU (p0.001) than the survivors and patient without ICU admission respectively. The AUC of uNGAL for diagnosis of AKI was 0.892 with a cutoff > 33 ng/ml providing specificity 90% and sensitivity 79%. In multivariate regression analysis, uNGAL was highly significant independent predictor of inpatient cirrhosis relayed mortality. Conclusion: UNGAL is a promising biomarker for diagnosis of AKI and differentiation between its different aetiologies in cirrhosis including ATN, HRS and pre renal azotemia. UNGAL can independently predict poor short term prognosis.

Introduction: Acute kidney injury is associated with increased mortality in hospitalized cirrhotic patients; therefore early and accurate diagnosis is crucial. The prognosis of AKI in cirrhosis depends on its specific aetiology which remains a challenge. Aim: We aimed to determine the accuracy of urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) for diagnosis, differentiation of the various aetiologies of AKI in cirrhotics and to evaluate its value in short term prognosis. Methods: Eighty-two cirrhotic patients were investigated for uNGAL during hospital admission and AKI types were determined blinded to uNGAL measurements. Patients were followed up till discharge. Results: Patients with liver cirrhosis and renal impairment (n= 62) had significantly higher levels of uNGAL (102.4 ±100 ng/ml) when compared with patients with cirrhotics with normal kidney function (n= 20) (102.4 ±100 vs 17.4±14.71 ng/ml). Patients with acute tubular necrosis (ATN) had significantly higher uNGAL (189.2±124 ng/ml) compared to other aetiologies, while prerenal azotemia had the lowest value (46.1±39.9 ng/ml). UNGAL levels were significantly higher in the mortality group of patients (p=0.006) and in patients admitted to ICU (p0.001) than the survivors and patient without ICU admission respectively. The AUC of uNGAL for diagnosis of AKI was 0.892 with a cutoff > 33 ng/ml providing specificity 90% and sensitivity 79%. In multivariate regression analysis, uNGAL was highly significant independent predictor of inpatient cirrhosis relayed mortality. Conclusion: UNGAL is a promising biomarker for diagnosis of AKI and differentiation between its different aetiologies in cirrhosis including ATN, HRS and pre renal azotemia. UNGAL can independently predict poor short term prognosis.

Introduction: Acute kidney injury is associated with increased mortality in hospitalized cirrhotic patients; therefore early and accurate diagnosis is crucial. The prognosis of AKI in cirrhosis depends on its specific aetiology which remains a challenge. Aim: We aimed to determine the accuracy of urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) for diagnosis, differentiation of the various aetiologies of AKI in cirrhotics and to evaluate its value in short term prognosis. Methods: Eighty-two cirrhotic patients were investigated for uNGAL during hospital admission and AKI types were determined blinded to uNGAL measurements. Patients were followed up till discharge. Results: Patients with liver cirrhosis and renal impairment (n= 62) had significantly higher levels of uNGAL (102.4 ±100 ng/ml) when compared with patients with cirrhotics with normal kidney function (n= 20) (102.4 ±100 vs 17.4±14.71 ng/ml). Patients with acute tubular necrosis (ATN) had significantly higher uNGAL (189.2±124 ng/ml) compared to other aetiologies, while prerenal azotemia had the lowest value (46.1±39.9 ng/ml). UNGAL levels were significantly higher in the mortality group of patients (p=0.006) and in patients admitted to ICU (p0.001) than the survivors and patient without ICU admission respectively. The AUC of uNGAL for diagnosis of AKI was 0.892 with a cutoff > 33 ng/ml providing specificity 90% and sensitivity 79%. In multivariate regression analysis, uNGAL was highly significant independent predictor of inpatient cirrhosis relayed mortality. Conclusion: UNGAL is a promising biomarker for diagnosis of AKI and differentiation between its different aetiologies in cirrhosis including ATN, HRS and pre renal azotemia. UNGAL can independently predict poor short term prognosis.

Introduction: Acute kidney injury is associated with increased mortality in hospitalized cirrhotic patients; therefore early and accurate diagnosis is crucial. The prognosis of AKI in cirrhosis depends on its specific aetiology which remains a challenge. Aim: We aimed to determine the accuracy of urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) for diagnosis, differentiation of the various aetiologies of AKI in cirrhotics and to evaluate its value in short term prognosis. Methods: Eighty-two cirrhotic patients were investigated for uNGAL during hospital admission and AKI types were determined blinded to uNGAL measurements. Patients were followed up till discharge. Results: Patients with liver cirrhosis and renal impairment (n= 62) had significantly higher levels of uNGAL (102.4 ±100 ng/ml) when compared with patients with cirrhotics with normal kidney function (n= 20) (102.4 ±100 vs 17.4±14.71 ng/ml). Patients with acute tubular necrosis (ATN) had significantly higher uNGAL (189.2±124 ng/ml) compared to other aetiologies, while prerenal azotemia had the lowest value (46.1±39.9 ng/ml). UNGAL levels were significantly higher in the mortality group of patients (p=0.006) and in patients admitted to ICU (p0.001) than the survivors and patient without ICU admission respectively. The AUC of uNGAL for diagnosis of AKI was 0.892 with a cutoff > 33 ng/ml providing specificity 90% and sensitivity 79%. In multivariate regression analysis, uNGAL was highly significant independent predictor of inpatient cirrhosis relayed mortality. Conclusion: UNGAL is a promising biomarker for diagnosis of AKI and differentiation between its different aetiologies in cirrhosis including ATN, HRS and pre renal azotemia. UNGAL can independently predict poor short term prognosis.

Abstract: Objectives: To evaluate the prevalence of silent cerebral infarction (SCI) among neurologically free chronic kidney disease (CKD) patients as judged by brain MRI examinations. Patients & Methods: The study included 230 CKD patients; 165 males and 65 females with mean age of 58±7.9 years. Seventy-six patients (34%) had ischemic heart disease (IHD), 34 patients (14.8%) with non-ischemic heart diseases (Non-IHD), 196 patients (85.2%) had diabetes mellitus (DM), 173 patients (75.2%) were hypertensive patients and dyslipidemia was detected in 185 patients (80.4%). All patients underwent categorization according estimated glomerular filtration rate (eGFR) and all underwent MRI examination. Results: Brain MRI defined SCI in 117 patients for a prevalence rate 50.9%. The frequency of patients had SCI was significantly higher in older patients with significantly higher mean age of those had SCI compared to those had MRI free of SCI. The presence of SCI showed positive significant correlation with age (r=0.278, p0.01), but showed a negative significant correlation with eGFR, (r=-0.249, p=0.001). The frequency of cardiac patients among those had CKD was significantly higher compared to non-cardiac patients with non-significant difference according to presence of ischemia. The frequency of diabetics among CKD patients was significantly higher compared to non-diabetics with significant prevalence among CKD patients with SCI. The frequency of hypertensive patients among CKD patients was significantly higher compared to normo-tensive patients with significantly higher frequency of hypertensive patients among patients had SCI. However, the frequency of dyslipidemic patients among CKD with or without SCI was non-significant. Conclusion: The frequency of SCI as judged by brain MRI was high among neurologically free CKD patients especially the older one and if associated with IHD, type-2 DM and/or hypertension. Also, such frequency was negatively correlated eGFR as a measure for renal function.

Abstract Background: Vaspin is an adipokine that is potentially linking obesity, insulin resistance, metabolic syndrome and type-2 diabetes. Aim: The present study aimed to investigate the impact of vaspin rs2236242 gene polymorphism on the risk of obesity, diabetes, their metabolic traits, and serum vaspin levels in a sample of Upper Egyptian women. Subjects and methods: A total of 224 subjects, 112 obese (62 non diabetics, 50 diabetics) and 112 controls were included in this case control study. Vaspin gene rs2236242 polymorphism was performed using etraamplification refractory mutation system-polymerase chain reaction (T-ARMS-PCR) and serum vaspin levels were estimated by ELISA. Results: The minor (A) allele of vaspin rs2236242 gene polymorphism was significantly lower in obese (30.8%) than controls (43.7%) (P = 0.005). The protective effect was evident in dominant and recessive inheritance models (TT vs TA + AA, P = 0.004 and TT + TA vs AA, P = 0.036). After adjusting genotypes for diabetes there were no significant association between vaspin rs2236242 gene polymorphism and obesity but significant association was maintained in the obese diabetics. Vaspin serum levels were found to be lower in minor protective (AA) genotype carriers than the other two genotypes (P 0.001). In the mean-time serum vaspin levels were significantly higher in obese diabetics and non-diabetics than controls (P 0.001each).There were significant positive correlations between vaspin levels and hs-CRP, cholesterol, LDL-C, fasting glucose, HOMAIR, insulin, and ALT values (P 0.05 each) and a negative correlation with HDL-C (P 0.01). Conclusion: The minor A allele of vaspin rs2236242 polymorphism plays a protective role against obesity and diabetes but this relation is largely ascribed to its effect on insulin resistance. The serum vaspin concentration was lower in minor protective allele carriers. To the best of our knowledge, this is the first study of vaspin SNP in Upper Egyptian women. The entire understanding of vaspin intimate mechanistic action might enable the development of novel etiology-based treatment strategies for obesity, the complex genetic trait.