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Background :Acute kidney injury(AKI) is common in cirrhosis but differential diagnosis remains a challenge. Serum creatinine (SCr) less sensitive in reflecting renal dysfunction in cirrhotic patients. Aim of the Work: to study the usefulness of NGAL as an early biomarker of AKI in cirrhotic patients. Subjects and Methods: 80 subjects included, classified into 3 groups: GroupΙ: 10 control subjects. Group Π (GpΠ): 40 compensated hepatic patients without AKI, further subdivided into four subcategories: (GpΠa1): 10 patients with HCV under interferon plus ribavirin therapy. (GpΠa2): 10 patients with HCV not under interferon or ribavirin therapy. (GpΠb): 10 patients with Bilharzial liver fibrosis. (GpΠc): 10 patients with combined HCV and Bilharzial liver fibrosis. Group Ш (GpШ): 30 decompensated hepatic patients with AKI, further subdivided into three subcategories: (Gp Шa): 10 patients with Acute tubular necrosis. (Gp Шb): 10 patients with hepatorenal syndrome. (Gp Шc): 10 patients with Pre-renal azotemia. All participants were subjected to the routine lab investigations in addition to specific lab test plasma NGAL (pNGAL).Results: No significant difference was found in kidney function parameters (SCr, urea, GFR) between patients with AKI and patients without AKI. However, patients with AKI had higher pNGAL compared to patients without AKI. There were significant difference among group III subcategories, patients with ATN had pNGAL levels markedly higher (mean 295 ng/ml) compared to those of patients with PRA (mean 86.5 ng/ml), Patients with HRS had intermediate values {mean 142 ng/ml}. In patients with ATN, pNGAL markedly rise within 3 hrs of kidney injury compared to SCr which rises after 24 hrs. Among GpΠ subcategories, no significant difference was found in either pNGAL or kidney function parameters. Conclusions: pNGAL is an early biomarker of AKI and it can also discriminate type of AKI in cirrhosis

 Background: Recent improvements in radio-diagnostic procedures and in cardiovascular percutaneous interventions, together with increased life expectancy, have resulted in the subjection of an increasing number of patients to contrast medium-enhanced examinations or cardiac and angiographic procedure requiring iodinated contrast medium injection.  Subjects and methods: This study was carried out at Internal Medicine, Cardiology, Radiology and Clinical Pathology departments, Zagazig University Hospitals. The study was approved by Institutional Review Board (IRB) and included a total of 60 patients.  Based on the development of contrast induced nephropathy after IV administration of high osmolar contrast agent, Patients were classified into CIN and NO CIN groups. We measured serum neopterin and IL-10 and calculating neutrophil to lymphocyte ratio before contrast administration, 24 and 48 hours after in 45 patients underwent coronary angiography for diagnostic and therapeutic purposes and 15 patients underwent renal angiography.  Results: About 25 % of the present studied patients (14 patients) fulfilled the criteria of contrast nephropathy with more cases in the percutaneous coronary angiography group (11 patients).This study revealed that serum neopterin, IL 10 and neutrophil to lymphocyte ratio were higher in patients with CIN following IV contrast media at 24 & 48 hours compared to patients without CIN. In our study; we found increased preprocedural and post-procedural CRP, ESR and uric acid levels at 48 hours in patients with CIN. We found a decreased basal serum total bilirubin level in patients with CIN following IV contrast media compared to patients without CIN.  Conclusion: Serum neopterin, IL 10 and neutrophil to lymphocyte ratio proved that they can be used as early biomarkers of contrast induced nephropathy instead of serum creatinine as they rise 24 hours before any change in the serum creatinine. Decreased serum total bilirubin levels had a higher incidence of CIN after the use of contrast media. Measuring ESR & CRP levels at admission may offer additional assistance in predicting the development of CIN. Elevated serum uric acid level is independently associated with an increased risk of CIN.  Abbreviations: CIN = Contrast induced nephropathy, AKI = Acute kidney injury, CRP = C-reactive protein, NLR= Neutrophil to lymphocyte ratio, ESR = Erythrocyte sedimentation rate, UA = Uric acid, eGFR = estimated glomerular filtration rate.

Background: Hepatitis C virus infection has strong relationship with insulin resistance in general population. Insulin resistance increases risk of cardiovascular events in chronic kidney disease patients.This work is intended to study the interrelation between Hepatitis C virus infection and insulin resistance among end stage renal disease patients on regular hemodialysis. Methods: It included a total number of 90 subjects. They were divided into two groups: Group 1 (45 subjects Hepatitis C viruspositivepatientson regular hemodialysis), Group 2 (45 subjects Hepatitis C virusnegative patients on regular hemodialysis).All patients included in this study were subjected to the following: Full clinical assessment,Complete blood picture, alanine aminotransferase, aspartate aminotransferase, creatinine, blood urea, fasting plasma glucose, Coagulation profile, serum calcium, serum phosphorus, serum parathyroid hormone, Hepatitis C virusantibodies, human immunodeficiency virus antibodies, hepatitis surface antigen, fasting serum insulin and fasting serum C-peptide. Results: Our study reported that no statically significant difference in Homeostatic model assessment of insulin resistance between the two studied groups. Homeostatic model assessment of insulin resistance has significant correlation to age, weight, body mass index,serum parathyroid hormone, serum creatinine, urea reduction ratio and serum ferritin. Conclusion: We couldn't detect any strong correlation between Hepatitis C virus seropositivity and insulin resistance in hemodialysis patients, but we detected strong relationship of insulin resistance to age, weight, body mass index, serum parathyroid hormone, serum creatinine, urea reduction ratio and serum ferritin in hemodialysis patients.