| Abstract: |
SUMMARY AND CONCLUSIONThis study was carried out at Zagazig University hospitals, Internal Medicine Department and Nephrology unit in the period between January 2002 to August 2004 to study the expression of CD14+CD16+ monocytes and serum M-CSF levels in patients with chronic renal failure either predialysis or under regular hemodialysis and to correlate these cells to the chronic complications of uremia.100 subjects were included in this study. They were classified into 3 main groups and 3 subgroups.I. Group I: Included 20 healthy volunteers as a control group.II. Group II: Included 20 patients with chronic renal failure on conservative treatment (with no history of any dialysis before).III. Group III: Included 60 patients with chronic renal failure on regular hemodialysis. This group was subdivided into3 subgroups:Group IIIA: 20 patients with chronic renal failure on regular hemodialysis for less than 1 year.Group IIIB: 20 patients with chronic renal failure on regular hemodialysis from 1 to 5 years .Group IIIC: 20 patients with chronic renal failure on regular hemodialysis for more than 5 yearsAll subjects were subjected to thorough history taking, full clinical examination and routine investigations including renal function tests (serum creatinine and urea levels), creatinine clearance, fasting and postprandial blood glucose, serum uric acid, serum calcium, serum phosphorus, serum alkaline phosphatase, erythrocyte sedimentation rate, liver function tests, C-reactive protein, complete blood count including total and differential leucocytic counts, resting 12 leads electrocardiography, chest X-ray, abdominal and pelvic ultrasonography, echocardiography (when indicated), measurement of total monocytes and CD14+CD16+ monocytes levels and serum M-CSF assay.The results of this study are summarized as follows:• Total blood monocytes were significantly increased in patients with chronic renal failure compared to normal controls.• Total monocytes showed no significant difference between predialysis patients and patients on regular hemodialysis. No significant difference was found also between patients on different durations of hemodialysis.• The proinflammatory subset of monocytes (CD14+ CD16+ monocytes) were significantly increased in patients with chronic renal failure under regular hemodialysis compared to normal controls and predialysis patients.• CD14+ CD16+ monocytes showed significant positive correlation with the increased duration of hemodialysis.• Serum M-CSF levels were significantly increased in patients with chronic renal failure compared to normal controls.• Serum M-CSF levels showed significant positive correlation with the increased duration of hemodialysis.• Serum M-CSF levels were significantly correlated to CD14+ CD16+ monocytes.• CD14+ CD16+ monocytes showed significant negative correlation to hemoglobin concentrations.• CD14+ CD16+ monocytes showed significant negative correlation to serum albumin levels.• CD14+ CD16+ monocytes showed significant positive correlation to serum levels of C-reactive protein.ConclusionOur study showed that total blood monocytes and serum M-CSF levels are increased in all uremic patients and that CD14+ CD16+ monocyte expression is increased in uremic patients under regular hemodialysis with a significant correlation with serum M-CSF levels and a significant correlation to hemodialysis duration. The increased CD14+ CD16+ monocyte expression is therefore related to the hemodialysis procedure itself and this phenomenon is not only related to biocompatibility of dialysis membranes being increased in our patients depite using polysulfone membrane and there should be another factors such as contaminated dialysate or polysufone membrane is not 100% biocompatible.Increased CD14+ CD16+ monocyte in uremic of patients showed a significant correlation with the degree of anemia, hypoalbuminemia and C-reactive protein levels. This might indicate that CD14+ CD16+ monocytes and M-CSF are involved in the pathophysiology of chronic complications of uremia and hemodialysis.
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