الفهرس 
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Abstract
Chronic kidney disease (CKD) is a worldwide public health problem with an increasing incidence and prevalence, poor outcomes and high cost. CKD is a progressive disease characterized by an increasing inability of the kidney to maintain normal low levels of the products of protein metabolism (e.g., urea), normal blood pressure and hematocrit and sodium, water, potassium, and acid-base balance.
There is a need for markers that can predict the initiation and progression of CKD in an early phase. This would enable intervention or change in therapy. In clinical practice, estimates of glomerular filtration rate (GFR) and proteinuria are used for identification of patient at increased risk of progression of CKD.
Cystatin C (CysC) is a nonglycosylated protein belonging to the cysteine protease inhibitors and is produced at a constant rate in all nucleated cells; it is removed from blood plasma by glomerular filtration and reabsorbed by the renal tubules. Moreover, its concentration is not influenced by diet, age, gender, lean muscle mass, and/or infections. Several studies suggested that CysC is a better marker of GFR than serum creatinine (S.Cr).
Biopsy is considered the “gold standard” for many pathological evaluations, but in the latter years non-invasive methods have attempted to replace this invasive procedure. Acoustic Radiation Force Impulse (ARFI) imaging is a new ultrasound (US) imaging modality to evaluate the stiffness of tissues that provides numerical measurements (wave-velocity values) of tissue stiffness attempting to replace this invasive procedure.
The aim of this work was to assess renal fibrosis by ARFI quantification and their correlation to renal function and hemodynamic in patients with CKD with different stages of the disease according to the severity of renal damage and the level of GFR.
The present study included 60 subjects. They were classified into two groups:
Group I:
Forty patients with chronic kidney disease were included. They were 19 females and 21 males. Their ages ranged between 14-65 years with a mean 41.28 ±15.34 years.
Group II:
Twenty healthy subjects of matched age and sex were included as controls. They were 9 females and 11 males. Their ages ranged between 16-61years with a mean 38.35±11.46 years.
The study was conducted in accordance with the ethical guidelines of the 1975 Declaration of Helsinki and Good Clinical Practice guidelines. An informed consent was obtained from each patient and control in the study.
All CKD patients in the present study were subjected to thorough history taking and thorough clinical examination