Stem cell biology and regenerative medicine, Nov 19, 2016
Diabetes mellitus is a widespread chronic disease. Type 1 diabetes mellitus (DM) requires insulin... more Diabetes mellitus is a widespread chronic disease. Type 1 diabetes mellitus (DM) requires insulin replacement for life. Pancreatic islets or the whole organ transplantation is an ideal alternative, but is hampered by shortage of cadaveric organs. Type 2 DM can be initially controlled by medication, but eventually one third of patients become insulin dependent. Efforts to develop insulin-producing cells (IPCs) from a variety of sources are under investigation. In view of their high proliferation rate and trilineage potential, embryonic stem cells (ESCs) offer an attractive source for stem cell therapy in DM. However clinical application of ESCs has several concerns including teratogenicity, immunogenicity, and ethical considerations. These drawbacks may be overcome by manipulation of the transplanted cells via encapsulation. Induced pluripotent stem cells have similar properties to ESCs as they exhibit high proliferation and trilineage potential. Most importantly, they offer the possibility of producing autologous cells. However, the rate of conversion of somatic cells into pluripotency is very low. Mesenchymal stem cells from a variety of sources are used to get insulin-producing cells either by genetic manipulations or directed differentiation. The proportion of the resulting functional cells is small. However transplantation in nude mice results in euglycemia. Evidence had been provided that this is the result of further maturation in vivo.
Experimental and Clinical Transplantation, Feb 1, 2022
OBJECTIVES Death with graft function is one of the most catastrophic events after kidney transpla... more OBJECTIVES Death with graft function is one of the most catastrophic events after kidney transplant. Various pre and posttransplant risk factors have been linked to death with graft function. Characterization of this event is crucial to set successful preventive measures. Here, we reported on death with graft function among living donor kidney transplant recipients seen at the Urology and Nephrology Centre at Mansoura University (Mansoura, Egypt) throughout a period of >4 decades. MATERIALS AND METHODS This single-center study included 2953 patients who received living donor kidney transplant between March 1976 and December 2018. Patient data were retrospectively analyzed. Patients who had death with graft function were compared with other patients with regard to pre- and posttransplant data. Causes of death with graft function were also studied. RESULTS Among our patients (1654 male [56%] and 1299 female [44%] patients), death with graft function was reported in 9.9% of patients and responsible for 58.3% of deaths and 24.6% of graft losses. Male sex, pretransplant dialysis and blood transfusion, pre- and posttransplant diabetes and hypertension, high HLA mismatches, antithymocyte globulin induction, steroid and cyclosporine use, steroid dose, acute rejection episodes, and posttransplant infections and malignancy were significantly higher among the death with graft function group. However, multivariate analyses showed that only pretransplant diabetes, steroid dose, and posttransplant infections were risk factors for death with graft function. The most common causes of death with graft function were cardiovascular disease, infections, and malignancy. CONCLUSIONS Death with graft function remains a significant hindrance to competent kidney transplant outcomes. We found that the most common contributors to this major event were cardiovascular disease, infections, and malignancy. More attention is needed to modify risk factors of cardiovascular disease, to update implementation policies for posttransplant vaccinations, and to conduct increased malignancy surveillance, as well to adopt less aggressive immunosuppression regimens.
ABSTRACT Recent findings suggest that bone marrow stem cells have the capacity to differentiate i... more ABSTRACT Recent findings suggest that bone marrow stem cells have the capacity to differentiate into a variety of cell types. This would provide a potentially unlimited source of islet-like cells for transplantation and a promising therapy for diabetes mellitus. Here in, the differentiation ability of adult rat bone marrow mesenchymal stem cells (MSCs) to form glucose-regulating insulin-producing cells was studied. MSCs were obtained from rat long bones. After their expansion and at the end of passage 3, cells were cultured in a glucose rich medium containing DMSO for 3 days. The cells were cultured for 15 days in high glucose medium supplemented with pancreatic extract, then in low glucose and low serum medium containing nicotinamide and exendin-4 for another 7 days. Evaluation of differentiated cells included expression of endocrine genes, Immunoassaying, in vitro insulin release in response to glucose challenge. After three passages, flow cytometric analysis of undifferentiated cells showed purified mesenchymal cell as they were negative for CD34, CD45, and CD14, meanwhile they expressed high levels of CD29, CD44, and CD106. After 25 days of differentiation culture, the cells formed islet-like clusters. These were expressed insulin and endocrine-specific transcription genes. They were positively stained for insulin and C-peptide. Insulin was secreted in a dose response fashion as a function of increasing glucose concentrations. Evidence was provided that rat MSCs may include pancreatic progenitor cells capable of differentiating into functioning endocrine hormone-producing cells. This finding suggests a possible mean for treatment of diabetes mellitus.
Saudi Journal of Kidney Diseases and Transplantation, 2021
Immunosuppressive therapy is the backbone to renal transplantation. Although an adequate level of... more Immunosuppressive therapy is the backbone to renal transplantation. Although an adequate level of immunosuppression is required to dampen the immune response to the allograft, the level of chronic immunosuppression is slowly decreased over time (as the risk of acute rejection decreases) to help lower the overall risk of infection and malignancy. Several studies have discussed the clinical use of therapeutic drug monitoring of mycophenolic acid (MPA) in kidney transplant recipients. This prospective single-center study included 88 patients with end-stage renal disease who were transplanted in Mansoura Urology and Nephrology Center from living related donors, from the beginning of February 2016 to the end of December 2016. Eight patients were excluded, the remaining 80 patients were divided into two groups; the study group (40 patients) who were followed up using therapeutic trough level monitoring of MPA and, control group (40 patients) who were followed up using the fixed-dose of Mycophenolate according to our local immunosuppressive protocol. These patients were followed up for one year posttransplantation with regard to graft function, rejection episodes, gastrointestinal (GI), and hematological side effects, the incidence of infection or malignancy, patient survival, and graft survival. Fifteen patients from the study group (37.5%) needed dose reduction of MPA, no patients needed to increase the dose. Our study showed insignificant differences regarding the patients’ characteristics and demographic data. Significantly higher incidence of GI manifestations was noted in the control group (P = 0.001). Although the higher frequency of incidence of infection, anemia, leukopenia and thrombocytopenia was seen in the fixed- dose group, the difference was statistically insignificant. Regarding proteinuria and post-transplant diabetes mellitus, comparable data were obtained. Significantly higher percentage of recipients in the study group is still having normally functioning grafts (P = 0.02). Furthermore, higher percent of recipients in the control group died with functioning graft after one year of follow-up (P = 0.04). There were insignificant differences as regarding patient and graft survival. The decrease in the dose of MPA reduced the annual cost by around six thousand US dollars. Our results suggest that adopting therapeutic dose monitoring strategy during follow-up of kidney transplant recipients is adequate. Longer-term studies with a larger sample size may be needed to support this policy.
Journal of The Egyptian Society of Nephrology and Transplantation, 2016
Aim/Objectives/Background Systemic Lupus Erythematosis (SLE) is a systemic autoimmune disease aff... more Aim/Objectives/Background Systemic Lupus Erythematosis (SLE) is a systemic autoimmune disease affects multiple organs with clinically heterogeneous outcomes. Lupus Nephritis (LN) is a common complication of systemic lupus erythematosus, and it occurs in 31–65% of SLE patients. kidney transplantation is the best long-term option for patients with End Stage renal Disease. The aim of this work is then to assess the patient and graft outcome for those who reached end stage renal disease and received kidney transplantation at urology and nephrology center, mansoura university. Subjects and Methods The material of this section include 23 kidney transplant recipients due to lupus nephritis. A 46 matched kidney transplant patients who were diagnosed as end stage renal disease due to other causes will serve as control group. Results and Conclusions Results of the study showed no difference in patient and graft outcome between kidney transplant recipients due to lupus nephritis and kidney transplant recipients due to other causes. The risk of recurrence of lupus nephritis in the graft is very low if compared with FSGS or MPGN. We concluded that kidney transplantation for lupus patients is safe and carries no risk for lower patient or graft survival. The risk of recurrence is much lower if compared with other glomerular diseases.
Diabetes mellitus can be treated with islet transplantation, although there is a scarcity of dono... more Diabetes mellitus can be treated with islet transplantation, although there is a scarcity of donors. This study investigated whether human mesenchymal stem cells (MSCs) from umbilical cord stroma could be induced to differentiate into insulin-producing cells and the effects of retro-orbital injection of human insulin-producing cells for the treatment of nonobese diabetic (NOD) mice. MSCs were isolated from human umbilical cord stroma and induced to differentiate into insulin-producing cells using differentiation medium. Differentiated cells were evaluated by immunocytochemistry, RT-PCR, and real-time PCR. C-peptide release, both spontaneous and after glucose challenge, was measured by ELISA. Insulin-producing cells were then transplanted into NOD mice. Blood glucose levels and body weights were monitored weekly. Human nuclei and C-peptide were detected in mouse livers by immunohistochemistry. Pancreatic β-cell development-related genes were expressed in the differentiated insulin-pr...
Background: Hematological abnormalities are common in systemic lupus erythematosus (SLE), includi... more Background: Hematological abnormalities are common in systemic lupus erythematosus (SLE), including anemia, which is often attributed to chronic disease. Hepcidin, an iron-regulatory protein influenced by inflammatory cytokines, plays a role in the anemia pathophysiology. This study aimed to investigate the role of hepcidin in the serum profiles of lupus nephritis patients with anemia. Methods: A prospective cohort study was conducted on 100 lupus nephritis patients at Mansoura University, Egypt. Two groups were identified based on hemoglobin levels: anemia (Hb < 12 g/dl) and non-anemia (Hb ≥ 12 g/dl). Demographic and clinical data were analyzed using appropriate statistical tests, including t-tests, chi-square, and Fisher's exact test. Results: Both groups had similar ages but differed significantly in gender distribution, with more females in the anemia group. BMI, diabetes mellitus, and hypertension rates were comparable between groups. The duration of lupus nephritis and ...
Experimental and Clinical Transplantation, Apr 1, 2019
Diabetic nephropathy is one of the main long-term diabetic microangiopathies that can complicate ... more Diabetic nephropathy is one of the main long-term diabetic microangiopathies that can complicate type 1 and 2 and other secondary forms of diabetes mellitus, including posttransplant diabetes mellitus. Posttransplant diabetes mellitus was initially reported in the 1960s, with case reports of recurrent and de novo diabetic nephropathy after kidney transplant reported in the early 2000s, mostly as a result of same-risk and precipitating factors of diabetic nephropathy as in native kidneys. The disease may appear early in view of the hyperfiltration risk of being a single grafted kidney. Here, we discuss risk factors, early serologic and genetic biomarkers for early detection, and strategies to avoid and delay the progression of diabetic nephropathy after posttransplant diabetes mellitus. In this overview of published literatures, we searched PubMed and MEDLINE for all articles published in English language between January 1994 and July 2018. Included studies reported on the prevalence, incidence, or determinants of post-transplant diabetes among renal transplant recipients and studies reporting diabetic nephropathy in their cohorts. Our review showed that avoidance or good control of posttransplant diabetes is the cornerstone in management of posttransplant diabetes mellitus and hence diabetic nephropathy. Control and avoidance can be commenced in the preparatory stage before transplant using validated genetic markers that can predict posttransplant diabetes mellitus. The use of well-matched donors with tailored immunosuppression (using less diabetogenic agents and possibly steroid-free regimens) and lifestyle modifications are the best preventative strategies. Tight glycemic control, early introduction of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, and possibly conversion to less diabetogenic regimens can help to delay progression of diabetic nephropathy.
Journal of the Egyptian Society of Nephrology, 2018
Ramadan fasting is one of the five pillars of Islam and is compulsory for all adult Muslims who h... more Ramadan fasting is one of the five pillars of Islam and is compulsory for all adult Muslims who have no medical or religious excuses. Ramadan fasting is defined as a complete abstinence from food, drink, medications, sexual activity, and smoking from dawn to dusk. Regarding the kind Islamic religion, patients have permission not to fast according to the medical advice. However, most Muslim patients express their desire to fast during Ramadan month and they are very broken when their physicians inform them not to fast. There are a lot of controversies regarding Ramadan fasting for chronic kidney diseases (CKD) and hemodialysis patients with absence of strict guidelines that help nephrologists in this issue. Renal transplant recipients who have stable kidney function for at least 1 year post-transplantation can fast with cautious follow-up. Risk of dehydration due to fasting for long periods especially in the summer season is the main concern for patients with kidney stone diseases. There is still no strong evidence if that Ramadan fasting can induce renal stone formation in susceptible patients or not. However, most studies have shown that fasting for this kind of patients with good hydration after breaking the fast may be allowed without significant risk of renal colic incidence. According to the last published guidelines by the International Diabetes Federation and Diabetes and Ramadan International Alliance, Chronic dialysis or CKD stages 4 and 5 and CKD stage 3 patients are considered to be at very high risk and high risk categories, respectively, and are exempted from fasting.
Stem cell biology and regenerative medicine, Nov 19, 2016
Diabetes mellitus is a widespread chronic disease. Type 1 diabetes mellitus (DM) requires insulin... more Diabetes mellitus is a widespread chronic disease. Type 1 diabetes mellitus (DM) requires insulin replacement for life. Pancreatic islets or the whole organ transplantation is an ideal alternative, but is hampered by shortage of cadaveric organs. Type 2 DM can be initially controlled by medication, but eventually one third of patients become insulin dependent. Efforts to develop insulin-producing cells (IPCs) from a variety of sources are under investigation. In view of their high proliferation rate and trilineage potential, embryonic stem cells (ESCs) offer an attractive source for stem cell therapy in DM. However clinical application of ESCs has several concerns including teratogenicity, immunogenicity, and ethical considerations. These drawbacks may be overcome by manipulation of the transplanted cells via encapsulation. Induced pluripotent stem cells have similar properties to ESCs as they exhibit high proliferation and trilineage potential. Most importantly, they offer the possibility of producing autologous cells. However, the rate of conversion of somatic cells into pluripotency is very low. Mesenchymal stem cells from a variety of sources are used to get insulin-producing cells either by genetic manipulations or directed differentiation. The proportion of the resulting functional cells is small. However transplantation in nude mice results in euglycemia. Evidence had been provided that this is the result of further maturation in vivo.
Experimental and Clinical Transplantation, Feb 1, 2022
OBJECTIVES Death with graft function is one of the most catastrophic events after kidney transpla... more OBJECTIVES Death with graft function is one of the most catastrophic events after kidney transplant. Various pre and posttransplant risk factors have been linked to death with graft function. Characterization of this event is crucial to set successful preventive measures. Here, we reported on death with graft function among living donor kidney transplant recipients seen at the Urology and Nephrology Centre at Mansoura University (Mansoura, Egypt) throughout a period of >4 decades. MATERIALS AND METHODS This single-center study included 2953 patients who received living donor kidney transplant between March 1976 and December 2018. Patient data were retrospectively analyzed. Patients who had death with graft function were compared with other patients with regard to pre- and posttransplant data. Causes of death with graft function were also studied. RESULTS Among our patients (1654 male [56%] and 1299 female [44%] patients), death with graft function was reported in 9.9% of patients and responsible for 58.3% of deaths and 24.6% of graft losses. Male sex, pretransplant dialysis and blood transfusion, pre- and posttransplant diabetes and hypertension, high HLA mismatches, antithymocyte globulin induction, steroid and cyclosporine use, steroid dose, acute rejection episodes, and posttransplant infections and malignancy were significantly higher among the death with graft function group. However, multivariate analyses showed that only pretransplant diabetes, steroid dose, and posttransplant infections were risk factors for death with graft function. The most common causes of death with graft function were cardiovascular disease, infections, and malignancy. CONCLUSIONS Death with graft function remains a significant hindrance to competent kidney transplant outcomes. We found that the most common contributors to this major event were cardiovascular disease, infections, and malignancy. More attention is needed to modify risk factors of cardiovascular disease, to update implementation policies for posttransplant vaccinations, and to conduct increased malignancy surveillance, as well to adopt less aggressive immunosuppression regimens.
ABSTRACT Recent findings suggest that bone marrow stem cells have the capacity to differentiate i... more ABSTRACT Recent findings suggest that bone marrow stem cells have the capacity to differentiate into a variety of cell types. This would provide a potentially unlimited source of islet-like cells for transplantation and a promising therapy for diabetes mellitus. Here in, the differentiation ability of adult rat bone marrow mesenchymal stem cells (MSCs) to form glucose-regulating insulin-producing cells was studied. MSCs were obtained from rat long bones. After their expansion and at the end of passage 3, cells were cultured in a glucose rich medium containing DMSO for 3 days. The cells were cultured for 15 days in high glucose medium supplemented with pancreatic extract, then in low glucose and low serum medium containing nicotinamide and exendin-4 for another 7 days. Evaluation of differentiated cells included expression of endocrine genes, Immunoassaying, in vitro insulin release in response to glucose challenge. After three passages, flow cytometric analysis of undifferentiated cells showed purified mesenchymal cell as they were negative for CD34, CD45, and CD14, meanwhile they expressed high levels of CD29, CD44, and CD106. After 25 days of differentiation culture, the cells formed islet-like clusters. These were expressed insulin and endocrine-specific transcription genes. They were positively stained for insulin and C-peptide. Insulin was secreted in a dose response fashion as a function of increasing glucose concentrations. Evidence was provided that rat MSCs may include pancreatic progenitor cells capable of differentiating into functioning endocrine hormone-producing cells. This finding suggests a possible mean for treatment of diabetes mellitus.
Saudi Journal of Kidney Diseases and Transplantation, 2021
Immunosuppressive therapy is the backbone to renal transplantation. Although an adequate level of... more Immunosuppressive therapy is the backbone to renal transplantation. Although an adequate level of immunosuppression is required to dampen the immune response to the allograft, the level of chronic immunosuppression is slowly decreased over time (as the risk of acute rejection decreases) to help lower the overall risk of infection and malignancy. Several studies have discussed the clinical use of therapeutic drug monitoring of mycophenolic acid (MPA) in kidney transplant recipients. This prospective single-center study included 88 patients with end-stage renal disease who were transplanted in Mansoura Urology and Nephrology Center from living related donors, from the beginning of February 2016 to the end of December 2016. Eight patients were excluded, the remaining 80 patients were divided into two groups; the study group (40 patients) who were followed up using therapeutic trough level monitoring of MPA and, control group (40 patients) who were followed up using the fixed-dose of Mycophenolate according to our local immunosuppressive protocol. These patients were followed up for one year posttransplantation with regard to graft function, rejection episodes, gastrointestinal (GI), and hematological side effects, the incidence of infection or malignancy, patient survival, and graft survival. Fifteen patients from the study group (37.5%) needed dose reduction of MPA, no patients needed to increase the dose. Our study showed insignificant differences regarding the patients’ characteristics and demographic data. Significantly higher incidence of GI manifestations was noted in the control group (P = 0.001). Although the higher frequency of incidence of infection, anemia, leukopenia and thrombocytopenia was seen in the fixed- dose group, the difference was statistically insignificant. Regarding proteinuria and post-transplant diabetes mellitus, comparable data were obtained. Significantly higher percentage of recipients in the study group is still having normally functioning grafts (P = 0.02). Furthermore, higher percent of recipients in the control group died with functioning graft after one year of follow-up (P = 0.04). There were insignificant differences as regarding patient and graft survival. The decrease in the dose of MPA reduced the annual cost by around six thousand US dollars. Our results suggest that adopting therapeutic dose monitoring strategy during follow-up of kidney transplant recipients is adequate. Longer-term studies with a larger sample size may be needed to support this policy.
Journal of The Egyptian Society of Nephrology and Transplantation, 2016
Aim/Objectives/Background Systemic Lupus Erythematosis (SLE) is a systemic autoimmune disease aff... more Aim/Objectives/Background Systemic Lupus Erythematosis (SLE) is a systemic autoimmune disease affects multiple organs with clinically heterogeneous outcomes. Lupus Nephritis (LN) is a common complication of systemic lupus erythematosus, and it occurs in 31–65% of SLE patients. kidney transplantation is the best long-term option for patients with End Stage renal Disease. The aim of this work is then to assess the patient and graft outcome for those who reached end stage renal disease and received kidney transplantation at urology and nephrology center, mansoura university. Subjects and Methods The material of this section include 23 kidney transplant recipients due to lupus nephritis. A 46 matched kidney transplant patients who were diagnosed as end stage renal disease due to other causes will serve as control group. Results and Conclusions Results of the study showed no difference in patient and graft outcome between kidney transplant recipients due to lupus nephritis and kidney transplant recipients due to other causes. The risk of recurrence of lupus nephritis in the graft is very low if compared with FSGS or MPGN. We concluded that kidney transplantation for lupus patients is safe and carries no risk for lower patient or graft survival. The risk of recurrence is much lower if compared with other glomerular diseases.
Diabetes mellitus can be treated with islet transplantation, although there is a scarcity of dono... more Diabetes mellitus can be treated with islet transplantation, although there is a scarcity of donors. This study investigated whether human mesenchymal stem cells (MSCs) from umbilical cord stroma could be induced to differentiate into insulin-producing cells and the effects of retro-orbital injection of human insulin-producing cells for the treatment of nonobese diabetic (NOD) mice. MSCs were isolated from human umbilical cord stroma and induced to differentiate into insulin-producing cells using differentiation medium. Differentiated cells were evaluated by immunocytochemistry, RT-PCR, and real-time PCR. C-peptide release, both spontaneous and after glucose challenge, was measured by ELISA. Insulin-producing cells were then transplanted into NOD mice. Blood glucose levels and body weights were monitored weekly. Human nuclei and C-peptide were detected in mouse livers by immunohistochemistry. Pancreatic β-cell development-related genes were expressed in the differentiated insulin-pr...
Background: Hematological abnormalities are common in systemic lupus erythematosus (SLE), includi... more Background: Hematological abnormalities are common in systemic lupus erythematosus (SLE), including anemia, which is often attributed to chronic disease. Hepcidin, an iron-regulatory protein influenced by inflammatory cytokines, plays a role in the anemia pathophysiology. This study aimed to investigate the role of hepcidin in the serum profiles of lupus nephritis patients with anemia. Methods: A prospective cohort study was conducted on 100 lupus nephritis patients at Mansoura University, Egypt. Two groups were identified based on hemoglobin levels: anemia (Hb < 12 g/dl) and non-anemia (Hb ≥ 12 g/dl). Demographic and clinical data were analyzed using appropriate statistical tests, including t-tests, chi-square, and Fisher's exact test. Results: Both groups had similar ages but differed significantly in gender distribution, with more females in the anemia group. BMI, diabetes mellitus, and hypertension rates were comparable between groups. The duration of lupus nephritis and ...
Experimental and Clinical Transplantation, Apr 1, 2019
Diabetic nephropathy is one of the main long-term diabetic microangiopathies that can complicate ... more Diabetic nephropathy is one of the main long-term diabetic microangiopathies that can complicate type 1 and 2 and other secondary forms of diabetes mellitus, including posttransplant diabetes mellitus. Posttransplant diabetes mellitus was initially reported in the 1960s, with case reports of recurrent and de novo diabetic nephropathy after kidney transplant reported in the early 2000s, mostly as a result of same-risk and precipitating factors of diabetic nephropathy as in native kidneys. The disease may appear early in view of the hyperfiltration risk of being a single grafted kidney. Here, we discuss risk factors, early serologic and genetic biomarkers for early detection, and strategies to avoid and delay the progression of diabetic nephropathy after posttransplant diabetes mellitus. In this overview of published literatures, we searched PubMed and MEDLINE for all articles published in English language between January 1994 and July 2018. Included studies reported on the prevalence, incidence, or determinants of post-transplant diabetes among renal transplant recipients and studies reporting diabetic nephropathy in their cohorts. Our review showed that avoidance or good control of posttransplant diabetes is the cornerstone in management of posttransplant diabetes mellitus and hence diabetic nephropathy. Control and avoidance can be commenced in the preparatory stage before transplant using validated genetic markers that can predict posttransplant diabetes mellitus. The use of well-matched donors with tailored immunosuppression (using less diabetogenic agents and possibly steroid-free regimens) and lifestyle modifications are the best preventative strategies. Tight glycemic control, early introduction of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, and possibly conversion to less diabetogenic regimens can help to delay progression of diabetic nephropathy.
Journal of the Egyptian Society of Nephrology, 2018
Ramadan fasting is one of the five pillars of Islam and is compulsory for all adult Muslims who h... more Ramadan fasting is one of the five pillars of Islam and is compulsory for all adult Muslims who have no medical or religious excuses. Ramadan fasting is defined as a complete abstinence from food, drink, medications, sexual activity, and smoking from dawn to dusk. Regarding the kind Islamic religion, patients have permission not to fast according to the medical advice. However, most Muslim patients express their desire to fast during Ramadan month and they are very broken when their physicians inform them not to fast. There are a lot of controversies regarding Ramadan fasting for chronic kidney diseases (CKD) and hemodialysis patients with absence of strict guidelines that help nephrologists in this issue. Renal transplant recipients who have stable kidney function for at least 1 year post-transplantation can fast with cautious follow-up. Risk of dehydration due to fasting for long periods especially in the summer season is the main concern for patients with kidney stone diseases. There is still no strong evidence if that Ramadan fasting can induce renal stone formation in susceptible patients or not. However, most studies have shown that fasting for this kind of patients with good hydration after breaking the fast may be allowed without significant risk of renal colic incidence. According to the last published guidelines by the International Diabetes Federation and Diabetes and Ramadan International Alliance, Chronic dialysis or CKD stages 4 and 5 and CKD stage 3 patients are considered to be at very high risk and high risk categories, respectively, and are exempted from fasting.
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Papers by Ayman Refaie