Background: Adherence of patients with End-Stage Renal Disease (ESRD) to Hemodialysis (HD), prescribed medications, diet and fluid restrictions is essential to get the desirable outcome and prevent complications. During COVID-19 pandemic, ESRD patients became more concerned with attending the HD sessions and following the protective measures because of the potential for increased susceptibility to COVID-19. The aim of this study was to evaluate the impact of the pandemic on patients' adherence to HD and medical regimens.Methods: Two hundred five ESRD patients on HD were interviewed with the ESRD Adherence Questionnaire (ESRD-AQ) and the Fear-of-COVID-19 Scale (FCV-19S). Clinical and laboratory correlates of adherence were retrieved from patients' records.Results: Self-reported adherence to HD showed that 19.5% were not adherent to HD during the pandemic compared to 11.7% before the pandemic (p < 0.001), with a significant agreement with the actual attendance of HD sessions (Kappa = 0.733,p < 0.001). Twenty-five patients (12.2%) had a history of COVID-19. The FCV-19S had a mean score of 18.8 and showed significant positive correlations with the pre-dialysis phosphorus and potassium. Multivariate analysis showed that the main predictors of non-adherence were the history of COVID-19, understanding and perception scores, and the Fear-of-COVID score.Conclusions: The COVID-19 pandemic adversely affected the adherence of ESRD patients to HD and medical regimen. Strategies to mitigate patients' fears of COVID-19 and improve their understanding and perceptions of adherence to HD and medical regimen should be adopted in HD centers during the pandemic.

Urokinase receptors regulate the interplay between inflammation, immunity, and blood clotting. The soluble urokinase plasminogen activator system is an immunologic regulator affecting endothelial function and its related receptor; the soluble urokinase plasminogen activator receptor (suPAR) has been reported to impact kidney injury. This work aims to measure serum levels of suPAR in COVID-19 patients and correlate the measurements with variable clinicolaboratory parameters and patient outcomes. In this prospective cohort study, 150 COVID-19 patients and 50 controls were included. The circulating suPAR levels were quantified by Enzyme-linked immunosorbent assay (ELISA). Routine COVID-19 laboratory assessments, including CBC, CRP, LDH, serum creatinine, and estimated glomerular filtration rates, were performed. The need for oxygen therapy, CO-RAD score, and survival rates was assessed. Bioinformatic analysis and molecular docking were run to explore the urokinase receptor structure/function and to characterize molecules as potential anti-suPAR therapeutic targets, respectively. We found higher circulating suPAR levels in COVID-19 patients vs. controls (p < 0.001). Circulating suPAR levels positively correlated with COVID-19 severity, the need for O₂ therapy, the total leukocytes count, and the neutrophils to lymphocyte ratio, while they were negatively correlated with the O₂ saturation level, albumin, blood calcium, lymphocytic count, and GFR. In addition, the suPAR levels were associated with poor prognostic outcomes such as a high incidence of acute kidney injury (AKI) and mortality rate. Kaplan–Meier curves showed a lower survival rate with higher suPAR levels. The logistic regression analysis confirmed the significant association of suPAR levels with the occurrence of AKI related to COVID-19 and with increased mortality probability within three months of COVID-19 follow-up. Some compounds that can act similarly to uPAR were discovered and tested by molecular docking to identify the possible ligand–protein interactions. In conclusion, higher circulating suPAR levels were associated with COVID-19 severity and could be considered a putative predictor of AKI development and mortality.

Diabetic nephropathy (DN) affects about one-third of patients with diabetes and can lead to end-stage renal disease despite numerous trials aimed at improving diabetic management. Non-coding RNAs (ncRNAs) represent a new frontier in DN research, as increasing evidence suggests their involvement in the occurrence and progression of DN. A growing body of evidence suggests that long non-coding RNAs (lncRNAs) and microRNAs (miRNAs) in DN signaling pathways might serve as novel biomarkers or therapeutic targets, although this remains to be fully explored. Our study included four groups, each comprising 40 adults: patients with diabetes (a) without albuminuria, (b) with microalbuminuria, (c) with macroalbuminuria, and a control group. All participants underwent history-taking and clinicolaboratory assessments, including CBC, fasting blood sugar, HbA1c, lipid profile, liver function, and renal function tests. Additionally, expressions of lncRNA H19, miRNA-29b, PI3K, AKT, mTOR, and HIF-1 alpha were assessed using qPCR. lncRNA H19 expression was upregulated in patients with albuminuria compared to the DM group. Furthermore, based on qPCR, the level of lncRNA H19 was negatively correlated with eGFR and miRNA-29b expression. On the other hand, the lncRNA H19 level was positively correlated with PI3K, AKT, mTOR, and HIF-1 alpha levels. We also found that the lncH19/miRNA-29b ratio was significantly increased in patients with DN and macroalbuminuria. In conclusion, lncRNA H19 was upregulated in patients with DN, and this increase was associated with miRNA29b downregulation. Therefore, our study suggests a novel link between the lncH19/miRNA-29b ratio and DN, indicating that it might serve as a potential biomarker for the dynamic monitoring of DN.

Background: Serum creatinine elevated by more than 25% or ≥0.5 mg/dl absolute from baseline within 48 hours of contrast administration is known as contrast-induced nephropathy (CIN). It is the third most common cause of iatrogenic acute kidney insult in hospitals and raises the risk of subsequent renal injury, length of hospitalization, and mortality rate, particularly in cardiac patients with multiple comorbidities (1). Many factors related to both the patient and the contrast affect the incidence of CIN; one of the independent risk factors is diabetes mellitus DM)(2). Aim: to evaluate the impact of diabetes mellitus on the incidence of CIN in cardiac patients to improve the patients’ outcomes. Subjects and Methods: pre-post study that included 62 patients recruited from the cardiac catheterization unit of Suez Canal University Hospital, Ismailia City, to assess the risk of CIN among diabetic and non-diabetic patients following coronary interventions. Results: The incidence of CIN in the study was 9.7%. There was no statistically significant difference in DM or its duration between the CIN and non-CIN groups. Glycemic control is crucial, as found by the statistically significant differences in HbA1C levels between CIN and non-CIN groups. The study found that the most significant risk factors for CIN were low EF%, anemia, high serum cholesterol, advanced age, and chronic kidney disease. Conclusions: Glycemic control is one of the most important risk factors for the development of CIN as opposed to DM and its duration; strict glycemic control may improve patient outcomes.

Background: Contrast-induced acute kidney injury (CI-AKI) is a common complication of coronary angiography and percutaneous coronary interventions, with incidence rates ranging from 1% to 25%. Pre-existing renal impairment is the most significant predisposing factor. L-FABP has been evaluated as a biomarker for CIN. The aim of this study: The aim of this study was early detection of acute kidney injury after coronary angiography by detecting levels of L-FABP as a biomarker to improve the patient’s outcome. Methods: This is a Pre-post study, as we assessed urinary levels of L-FABP and serum creatinine before and after IV contrast. Sixty-two patients (42 males and 20 females) were recruited from the cardiac catheterization unit of Suez Canal University Hospitals in Ismailia City between December 2021 and January 2022. The study involved medical history, clinical examinations, blood samples for lipid, CBC, creatinine, HbA1C for diabetics, urine L-FABP measurement, and echocardiography. The Mehran score was calculated for each patient to predict risk for CIN and dialysis. Follow-up care for individuals diagnosed with CIN until recovery. Results: Nearly 70% had hypertension (HTN), 48.4% were diabetic, and 16% had CKD. The mean urinary L-FABP pre-contrast was 187.13 ± 59.07 ng/l, and post-contrast was 201.79 ± 81.8 ng/l. The incidence of CIN was 9.7%. urinary L-FABP levels showed a statistically significant difference within the first 6 h and after 48 h of contrast injection. Conclusion: In conclusion, CIN is prevalent in advanced-age patients with higher HbA1c levels in patients undergoing coronary interventions. Post-contrast levels showed a significant difference, suggesting potential for early renal injury detection.