الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Fibroblast growth factor 23 (FGF-23) is a recently discovered hormone that helps to maintain normal serum phosphate concentrations in patients with kidney disease by stimulating urinary phosphate excretion and decreasing dietary phosphorus absorption through the inhibition of 1,25- dihydroxyvitamin D [1,25(OH)2D] synthesis. Elevated concentrations of FGF-23 have been shown to non selectively activate FGF receptors implicated in the development of cardiac hypertrophy and atherosclerosis, suggesting a biological basis for an association between increased FGF-23 and mortality in CKD. Aim of the study is to evaluate the possible role of fibroblast growth factor 23 (FGF23) in the occurrence of left ventricular hypertrophy and vascular calcification in pre dialysis CKD patients. This study was conducted on forty 40 patients classified into two groups: group (I) 30 CKD patients (estimated glomerular filteration rate (eGFR) ≤ 90 mL/min/1.73m²) and group (II) 10 control subject with preserved kidney function defined by normal blood urea and serum creatinine. Group (I) CKD patients was further subclassifed according to presence or absence of Left ventricular hypertrophy and vascular calcification. Thorough history and examination was done stressing on cardiovascular complication and absence of exclusion criteria especially stage 5 CKD patients or history of renal replacement therapy. Routine and specific investigation was done. Group (I) CKD patients and group (II) Control patients were compared regarding clinical, laboratory and radiological features. Results of the present study revealed statistical significant difference between the studied groups as regard clinical, laboratory and 193 radiological features and showed high serum fibroblast growth factor 23 in chronic kidney diseases patients. There was significant difference between both Groups (CKD2-3) {30 ≤ GFR <90 ml/min./1.73m²} and (CKD 4) {15 ≤ GFR <29 ml/min./1.73m²} as regard serum calcium, Log. FGF23 (Ru/ml) and hemoglobin level (P value < 0.05).(Table 7). There was no significant difference between (CKD2-3) {30 ≤ GFR <90 ml/min./1.73m²} and (CKD 4) {15 ≤ GFR <29 ml/min./1.73m²} as regard to serum phosphorus (4.9±1.06) and (5.07 ± 0.6) respectively which means that even at late chronic kidney diseases stage serum phosphorus still within normal range. Also no significant difference as regard serum intact PTH (P value >0.05) (Table 7) . There was significant Correlation between Left Ventricular Hypertrophy measured by LVMI (g/m²) and age (years) (r= 0.45), BMI (g/m²) (r= 0.39), Estimated GFR. (MDRD) (ml/min./1.73m²) (r = -0.4), hemoglobin level (r= -0.45) in group (I) (r = 0.55) (P value < 0.05) (Table 17-18). There was significant Correlation between Left Ventricular Hypertrophy measured by LVMI (g/m²) and Log.FGF23 (Ru/ml) (r= 0.44) (P value < 0.05)(Table 18) .There was no significant Correlation between vascular Calcification measured by AAC score and Log.FGF23 (Ru/ml) in group (I) CKD patients (P value > 0.05) (Table 20-21).