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Background: Silent lupus nephritis (SLN) is a life menacing consequence of systemic lupus erythematous (SLE). This condition is characterized by pathological impairment of the kidney in the obscurity of clinical or laboratory manifestations.Objective: To reveal the existence of SLN along with the potential differences between overt lupus nephritis (OLN) and SLN among a sample of Egyptian patients based on histopathological assessment. Patients and Methods:It is a prospective case-control study which was performed at nephrology units, internal medicine department, Elhussein and Sayed Galal university hospitals, faculty of medicine, Al-Azhar University, Cairo, Egypt, throughout the entire period April 2016 to November 2019. Patients aged more than 18 years (216 months) and fulfilled at least 4 of the American College of Rheumatology criteria for the classification of systemic lupus erythematosus (SLE) were enrolled in the current study. Patients were further assorted into two groups; patients with SLN and those with OLN.Patients were subjected to the following investigations: 1.Complete blood count, using Coulter counter Max-M (Coulter Cooperation, Florida, USA) 2.Erythrocyte sedimentation rate, (Wester green method) (Ref: < 20mm/hr) 3.S. Albumin, S. Creatinine. Albumin/Creatinine ratio. Creatinine clearanc & eGFR using the Modification of Diet in Renal Disease (MDRD) formula. 4. Liver function tests. 5. Coagulation profile. 6. Urine analysis (Fresh morning midstream urine) to exclude infection. 7. Quantitative assessment of proteinuria by Pr/creat. Ratio (Ref. <0.2).Assessment of auto-antibodies and complement system: Autoantibodies to ds-DNA, RNP. SSA, SSB, Sm and Scl-70, C4 and C3 serum levels were assessed in all of the included patients. In particular, the titer of anti-dsDNA antibodies was evaluated by enzyme-Radiological evaluation: Patients were subjected to pelvi-abdominal ultrasound in order to obtain valuable data about the morphological appearance of the kidney and to detect any urological abnormality.Renal biopsy: Percutaneous renal biopsy was carried out under local anesthesia.Results: An overall 40 patients with SLE who developed lupus nephritis were enrolled in the current study. Among them, 20 patients had OLN, whereas 20 patients were SLN. Based on ISN/RPS Classification, stage II was the predominant stage, 13 patients, among patients with SLN, whilst stage V was the predominant stage among the OLN patients. Additionally, five and three patients were stage III among the SLN and OLN groups, respectively. Furthermore, the presence of RBCs Cast (r=0.479, P=0.032) in urine and decreased levels of complement (r=0.676, P=0.001) showed a statistically significant positive correlation with the high grades of lupus nephritis among SLN group. Conclusion:Patients with SLE should be subjected to close follow up evaluation and renal biopsy for early detection of SLN to determine the activity, severity, and chronicity of LN.

Background: Bone abnormalities are frequently developed in hemodialysis patients and people with chronic kidney disease (CKD). It results from aberrant bone turnover and a decline in bone mineral density (BMD). Aim of the work: With the help of dual energy X-ray absorptiometry in this study, poor bone mineral density in CKD patients at Al-Hussein University Hospital will be analysed for prevalence and severity. Patients and Methods: This Cross-Sectional research included 120 Patients (2 groups) 60 CKD Patients and 60 Hemodialysis Patients. The study has been conducted in Nephrology Unit Al-Hussien University Hospital. Result: In ESRD group there was Significant statistically (p-value = 0.008) T score femur and eGFR had a positive connection (r = 0.34). Significant statistically (p-value = 0.008) There is an r-value of 0.34 between the T score of the spine and the eGFR. While in CKD group significantly significant (p-value = 0.001) differences. T score femur and Creat have a negative connection (r = -0.41) with each other. Significant statistically (p-value = 0.001) T score femur and eGFR had a positive connection (r = 0.43). Significant statistically (p-value = 0.02) The T score forearm and the eGFR have a positive connection (r = 0.3). Conclusion: MBD are common features among CKD patients especially in late stages leading to Osteoporosis and fractures. Dual Energy X-Ray (DXA) could be utilized as efficient method for detection of the level of bone affliction in CKD patients and is essential for bone loss monitoring.

Background:The most significant complication of chronic kidney disease (CKD) is end-stage renal disease (ESRD). Hemodialysis (HD) necessitates a well-functioning vascular access with enough blood flow for clearance and blood dialysis. Thrombosis of the veins can be caused by both acquired and inherited factors. Aim of The Work: To to assess EPCR levels in patients with ESRD on hemodialysis & study relationship between the presence of EPCR gene polymorphisms (6936A/G) and incidence of vascular access thrombosis. Patients and Methods: This research was carried out on 50 studied cases admitted to the Theodor Bilharz Research Institute (TBRI), Imbaba, Giza, Hemodialysis Unit, Nephrology Department from November 2018 to May 2019. In addition, 25 age and sex-matched normal people (control cases) were included. Results: The mutant EPCR (6936A/G) genotypes were found to be substantially more prevalent in our investigation and the polymorphic type allele (G allele) in (p < 0.05) in ESRD patients on long-term hemodialysis with thrombosis compared to healthy subjects and ESRD patients without thrombosis. the flow cytometric expression of CD 201 was statistically reduced in ESRD patients on long-term hemodialysis with thrombosis (p < 00.01) & without thrombosis (p < 00.05) when compared to healthy subjects. CD201 Expression levels showed negative correlation with EPCR 6936 A/G heteromutant genotype. Conclusion: The result obtained via the recurrent study provide evidence that EPCR 6936A/G (rs867186) genetic polymorphisms in ESRD patients on long-term hemodialysis could be a potential reason for Venous thrombosis.

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