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‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
Under the supervision
of
Prof. Dr. Hassan Abd EL-Halim Amer
Professor of Biochemistry and Chemistry of Nutrition.
Faculty ...
Chronic Renal Failure (CRF):
Is defined as the renal injury of more prolonged nature which
often leads to progressive and ...
Several comorbidities occur in CRF including:
1-Biochemical alterations in blood parameters:
(uremia, hyperuricemia, hypoa...
 Anemia is defined as a decrease in the number of circulating
red blood cells (RBCs), reduction in the amount of hemoglob...
The average normal ranges of Hb varies by age and gender, in
adults are 14 to 18 g/dl in males, and 12 to 16 g/dl in fema...
Renal anemia
Anemia is universal in end stage renal disease (ESRD)
patients.
Renal anemia is defined as an Hb concentrat...
Various secondary causes can contribute to renal anemia,
including :
 Deficiency of iron
 Gastrointestinal bleeding
 Ac...
Inflammation and oxidative stress
Inflammation and oxidative stress causes anemia in patients
with CKD by several mechanis...
Treatment of Anemia
Anemia is corrected with the administration of erythropoiesis
stimulating agents (ESAs), the therapeut...
ESA hyporesponsiveness
ESA resistance has been defined by the European Renal
Association-European Dialysis and Transplant ...
Main factors causing EPO - resistant anemia:
1- Malnutrition
It is a relative common complication in chronic HD patients
a...
3- Iron deficiency
In HD patients iron deficiency can be :
 Absolute (eg, chronic blood retention in the dialysis
circuit...
 There is a clear interconnection between inflammation and
oxidative stress in ESRD patients on maintenance HD.
 Oxidati...
Aim of the work
The study was designed to :
1) Correlate the hemodialysis process in ESRD with the inflammatory
markers on...
4) All the previous changes will be judged together with
plasma osmolality and other blood chemistry parameters
(including...
The correlation of the hemodialysis process in ESRD with the
inflammatory markers on cellular level will be performed in
t...
Materials
&
Methods
Experimental Design:
From 200 ESRD outpatients , the study was focused on
80 ESRD categorized into 2 groups:
Group I
EPO p...
10 ml blood were taken just before and after the HD session
Blood collected in three types of vacutainer tubes
EDTA-blood
...
Citrated Plasma Estimation of plasma
osmolality
EDTA-blood samples
Detection of leucocytic
oxygen consumption
Parathrmone ...
EDTA-blood samples
Malondialdehyde level
DNA- fragmentation
Superoxide dismutase
Serum samples
Protein pattern analysis
Ferritin level
Interlukin6 (IL6)
C-reactive protein Total iron
Serum samples
Protein profile
Electrolytes
Liver function tests
Kidney function tests
SaltsLipids
PowerPoint Presentation.2015
PowerPoint Presentation.2015
PowerPoint Presentation.2015
PowerPoint Presentation.2015
PowerPoint Presentation.2015
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PowerPoint Presentation.2015

  1. 1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
  2. 2. Under the supervision of Prof. Dr. Hassan Abd EL-Halim Amer Professor of Biochemistry and Chemistry of Nutrition. Faculty of Veterinary Medicine, Cairo University Adel M. El-Behairy Mohamad Ali Warda Professor of Biochemistry and Professor of Biochemistry and Chemistry of Nutrition. Chemistry of Nutrition. Faculty of Vet. Medicine, Cairo Univ. Faculty of Vet. Medicine, Cairo Univ. Dr. Mohamed Hassan Shaheen Head of Laboratory Medicine Dept. Maadi Armed Forces Hospital
  3. 3. Chronic Renal Failure (CRF): Is defined as the renal injury of more prolonged nature which often leads to progressive and irreversible destruction of nephron mass, causing permanent reduction in glomerular filtration rate sufficient to produce detectable alterations in well-being and organ function.
  4. 4. Several comorbidities occur in CRF including: 1-Biochemical alterations in blood parameters: (uremia, hyperuricemia, hypoalbuminemia, electrolytes imbalance, metabolic acidosis, disorders in calcium and phosphorus metabolism, dyslipidemia) 2-Anemia. 3- Hypertension. 4- Development of cardiovascular diseases. 5- Oxidative stress.
  5. 5.  Anemia is defined as a decrease in the number of circulating red blood cells (RBCs), reduction in the amount of hemoglobin (Hb) in the RBCs, or combination of both.  Despite new therapeutic options and treatment strategies, anemia remains one of the major complications of CKD, especially in patients undergoing chronic hemodialysis (HD). Anemia of Chronic diseases
  6. 6. The average normal ranges of Hb varies by age and gender, in adults are 14 to 18 g/dl in males, and 12 to 16 g/dl in females . The presence of anemia in these patients reduces quality of life and contributes to symptoms of advanced renal failure, such as fatigue, reduced exercise tolerance, depression and dyspnea.  Anemia is associated with worsening of cardiovascular morbidity and accelerated rate of kidney damage, and it is an independent predictor of mortality in CKD patients
  7. 7. Renal anemia Anemia is universal in end stage renal disease (ESRD) patients. Renal anemia is defined as an Hb concentration of < 11.5 g/dl in women, and < 13.5 g/dl in men.  Primary cause of renal anemia is relative lack of erythropoietin hormone (EPO).
  8. 8. Various secondary causes can contribute to renal anemia, including :  Deficiency of iron  Gastrointestinal bleeding  Active blood loss  Haemolysis  Aluminium overload Hypothyroidism Severe hyperparathyroidism Inflammatory conditions (acute and chronic inflammations which suppress erythropoiesis in the bone marrow)  Shortened red blood cell survival due to uremia  Deficiencies of folate and vitamin B12
  9. 9. Inflammation and oxidative stress Inflammation and oxidative stress causes anemia in patients with CKD by several mechanisms include:  The depletion of redox capacity and oxidation of membrane phospholipids in erythrocytes, both of which lead to a shortened life span of these cells.  Increased production of hepcidin hormone, that inhibits both intestinal absorption and mobilization of iron stores and induction of erythropoietin resistance.
  10. 10. Treatment of Anemia Anemia is corrected with the administration of erythropoiesis stimulating agents (ESAs), the therapeutic goal is to reach a Hb concentration between 11.0 and 12.0 g/dl. Correction of anemia in CKD patients, especially undergoing HD yields numerous benefits: 1) Higher tolerance for physical activity. 2) Improvement of cardiovascular functions. 3) Reduced the need for blood transfusions. 4) Better quality of life. 5) Reduced hospitalization. 6) Lower mortality.
  11. 11. ESA hyporesponsiveness ESA resistance has been defined by the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) as being present when patients do not achieve the recommended Hb target level (11–12 g/dl), despite a treatment with ESAs over several months with maintained doses of rhEPO higher than 300 IU/Kg/ week of epoetin.
  12. 12. Main factors causing EPO - resistant anemia: 1- Malnutrition It is a relative common complication in chronic HD patients and may lead to EPO-resistant anemia. 2- Hyperparathyroidism Secondary hyperparathyroidism is associated with bone marrow fibrosis, increased hemolysis, decreased erythropoiesis, reduce RBCs production and survival. As well as, reduce release and impaired response to EPO.
  13. 13. 3- Iron deficiency In HD patients iron deficiency can be :  Absolute (eg, chronic blood retention in the dialysis circuit, malnutrition, gastrointestinal bleeding, and frequent blood collections).  Functional (i.e., limitation of bone marrow erythropoietic activity by inability to mobilize sufficient iron from body storage sites); in this situation the body’s total iron stores may be normal.
  14. 14.  There is a clear interconnection between inflammation and oxidative stress in ESRD patients on maintenance HD.  Oxidative stress forms part of the inflammation mechanism.  HD is associated with an oxidative imbalance, in which oxidation of different lipids and proteins are predominant.  As well as, loss of some antioxidants during HD may contribute to this disorder 4- Inflammation and oxidative stress
  15. 15. Aim of the work The study was designed to : 1) Correlate the hemodialysis process in ESRD with the inflammatory markers on cellular level. 2) To address the potential coherent relation between hemodialysis and global inflammatory response in the form of C-reactive protein. 3) To screen the immune status by measuring serum immunoglobulin fractions and plasma protein foot-printing together with fluctuation in interlukin6 level that shades patient’s immune status.
  16. 16. 4) All the previous changes will be judged together with plasma osmolality and other blood chemistry parameters (including: Blood urea , serum creatinine, uric acid, total iron, calcium, phosphorus, total proteins, albumin, total bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total cholesterol, triacylglycerol, and blood glucose level).
  17. 17. The correlation of the hemodialysis process in ESRD with the inflammatory markers on cellular level will be performed in the form of: 1. Modulation of antioxidant enzyme (superoxide dismutase) expression. 2. Expected cell membrane deterioration (malondialdehyde level). 3. Accelerated apoptosis in the form of DNA-fragmentation.
  18. 18. Materials & Methods
  19. 19. Experimental Design: From 200 ESRD outpatients , the study was focused on 80 ESRD categorized into 2 groups: Group I EPO poor responder patients Group II EPO good responder patients
  20. 20. 10 ml blood were taken just before and after the HD session Blood collected in three types of vacutainer tubes EDTA-blood containing sodium citrate without anticoagulant Serum centrifugation containing EDTA Citrated Plasma
  21. 21. Citrated Plasma Estimation of plasma osmolality EDTA-blood samples Detection of leucocytic oxygen consumption Parathrmone level Complete blood count
  22. 22. EDTA-blood samples Malondialdehyde level DNA- fragmentation Superoxide dismutase
  23. 23. Serum samples Protein pattern analysis Ferritin level Interlukin6 (IL6) C-reactive protein Total iron
  24. 24. Serum samples Protein profile Electrolytes Liver function tests Kidney function tests SaltsLipids
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    Oct. 16, 2021

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