Egypt, the single country with highest incidence of HCV infection in the world, has embarked on a government-sponsored mass treatment program using several combinations of DAAs. Recognizing the importance of extrahepatic manifestations, independently of the hepatic, a subcommittee was assigned to develop national guidelines for respective prioritizing indications and protocols. It evaluated the benefit of treating patients with different extrahepatic manifestations, and reviewed relevant clinical trials and guidelines concerning DAA combinations available in Egypt. The latter included Sofosbuvir plus either peg-interferon, Simeprevir, Ledipasvir or daclatasvir, and the Viekera family comprising paritaprevir/ritonavir + ombitasvir with (GT-1) or without (GT-4) Dasabuvir. Any of these protocols may be used with or without Ribavirin according to indication. A blueprint was subjected to peer debate in dedicated workshops in two national meetings and subsequently to an online professional review, eventually leading to a final report that was adopted by the health authorities. Seven compelling and 10 optional indications were identified for treating patients with predominantly extrahepatic manifestations. The former include kidney disease at different stages, cryoglobulinemic vasculitis and non-Hodgkin lymphoma. Selected treatment protocols, were encoded and their use was prioritized on the basis of evidence of efficacy and safety. We concluded that any of the studied protocols may be used, preferably with ribavirin, for 12-week treatment in all patients with extrahepatic manifestations without cirrhosis and with eGFR above 30 ml/min/1.73 sqm. Ribavirin should be included in protocols for treating patients with compensated cirrhosis. Daclatasvir-based protocols are recommended for decompensated cirrhosis, while the Viekera family is recommended in patients with eGFR < 30 ml/min/1.73 sqm, including those on dialysis. In kidney-transplanted patents, caution is due to avoidance of the pharmacokinetic interaction with the Cytochrome-P450 enzyme system, in-between immunosuppressive agents and most DAAs, particularly the Viekera family.

A patient registry is the collection of uniform data (clinical and others) to evaluate specified outcomes for a population defined by a particular disease or therapy (target disease or therapy) and that serves one or more predetermined scientific, clinical, or policy purposes. Our aim is to establish a renal database for hemodialysis patients (as a first step) that would help in providing the optimal health care to improve quality of life and prolong survival. Egyptian renal data system (ERDS) was established out of the firm belief that delivering a clear picture of the incidence, prevalence, and outcomes of hemodialysis-related problems in Egypt is the needed action to identify the real magnitude of the problem. ERDS is the Egyptian national registry of nephrology patients. It was founded and is run by the Egyptian Society of Nephrology and Transplantation (ESNT), the only official Egyptian Non-Governmental Organization representing nephrologists and officially managing some issues of the nephrology specialty in Egypt. ERDS until now registers data about patients with End stage kidney disease (ESKD) on chronic hemodialysis, but the plan is to include more patient groups in the future. Two types of data were collected; data about the dialysis units as a whole and data specific to each patient. Data entered by all units were exported from the digital system as a.csv file that can be opened by Microsoft Excel. Data analysis was carried out by Microsoft Excel functions and Microsoft Power Business Intelligence. Results were represented by different sectors.

Hepatitis C virus (HCV) infection is an important cause of major morbidities including chronic liver disease, liver cancer, acute kidney injury and chronic kidney disease (CKD). Among patients with kidney disease who have HCV infection, the clinical outcomes are worse. The prevalence of HCV infection is exceptionally high among dialysis and kidney transplant patients throughout the globe. It is estimated that 5% to 25% or more of dialysis-dependent patients are affected. Almost half of all deaths in CKD patients, including HCV-infected patients, are due to cardiovascular disease, and HCV-infected patients have higher mortality. Given the importance and impact of the HCV epidemic on global kidney health, and the status of Egypt as the nation with the highest prevalence of HCV infection in the world along with its initiatives to eradicate HCV, the International Federation of Kidney Foundations convened a consensus conference in Cairo in December 2017. This article reflects the opinions and recommendations of the contributing experts and reiterates that, with the current availability of highly effective and well tolerated pharmacotherapy, CKD patients should be given priority for the treatment of HCV, as an important step towards the World Health Organization’s goal of eliminating viral hepatitis as a public health problem by 2030.

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Given the uncertainty regarding the relationship between donor cells at microchimeric levels and its influence on graft function and clinical outcome, we explored the extent and importance of donor microchimerism in kidney transplantation. Twenty patients with chronic kidney disease who had received allografts from living donors were studied. We examined peripheral whole blood samples from the recipients one month after the transplant, applying mitochondrial DNA variant‐specific polymerase chain reaction (PCR) to identify and quantify donor cells in relation to allograft function and survival during three years of follow‐up. Higher quantities of donor‐derived cell microchimerism in the peripheral blood correlated with better graft function in the early postoperative period at 1 month (R2 = .536, p = .001) and predicted improved graft function 1 year following the transplant (R2 = .430, p = .008). Furthermore, early post‐transplant quantities of donor cell microchimerism were an important predictor of improved kidney function 3 years after transplantation (R2 = .397, p = .021). However, donor cell microchimerism failed to predict patient and graft survival after 3 years (odds ratio = 0.536, p = .860). Our findings suggest that donor cell microchimerism plays an immunoregulatory role in kidney transplantation and contributes to donor‐specific immune hypo‐responsiveness and graft acceptance.