الفهرس 
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Abstract
Persistent low-grade inflammation, a condition observed in a majority of patients with end-stage renal disease (ESRD), seems to be a player in most detrimental pathways leading to increased cardiovascular morbidity and mortality in this patient population .
Emerging evidence also suggests that low-grade persistent inflammation magnifies other common features of the uremic phenotype, such as atherosclerosis, depression, protein energy wasting (PEW) and vascular calcification and also play a role in MBD with disturbance in bone turnover, acting as a catalyst of the vicious circle of risk factors in ESRD . Because circulating inflammatory markers are sensitive predictors of outcome in patients with ESRD, inflammation is believed to be a potential primary therapeutic target for various nutritional and pharmacological interventions.
The role of persistent inflammation as a putative cause of the unacceptable high mortality rate in ESRD has attracted considerable interest in the last decades
The aim of these work was To study a possible correlation between inflammation detected by inflammatory biomarkers and CKD-MDB detected by clinical and laboratory finding.
The study will be conducted on 50 patients whom will be classified to 4 groups :
Group 1: included 10 patients with chronic kidney disease stage 3.
Group 2: included 10 patients with chronic kidney disease stage 4.
Group 3: included 10 patients with chronic kidney disease stage 5.
Group 4: included 20patients controls (CKD stage I,II).
It was a prospective cross-sectional study and followed the ethics committee of our university.
• Inclusion criteria:
Chronic kidney disease patients (stage I- stage V) before starting renal replacement therapy. The following patients were excluded from this study:
1. Patients have acute infections. 2. Patients have Malignancy.
3. Patients with chronic liver disease. 4. Patients have thyroid gland dysfunctions.
5. Patients have a recent myocardial infarction. 6. Patients have a recent trauma.
7. Patients have a recent physical stress. 8. Patients have non-steroidal anti-inflammatory for last three days, cortecosteroids intake, statins intakes.
9. Postmenopausal females.
Patientshave non-steroidalanti-inflammatoryfor lastthree days, cortecosteroids intake, statins intakes.
9.Postmenopausal females.
All studied groups were subjected to the follwings:
• Full history taking :
Including age, sex, previous medications and duration of diabetes mellitus.
• Clinical examination:
Stressing on blood pressure, neurological and cardiac examination, electrocardiogram
• Radiological:
X- ray on hands to determine bone changes due to bone
mineral disease.
X- ray on chest lateral view to determine if there is aortic calcifications
Echcardiography
Laboratory investigations Include:
• Fasting and post prandial blood glucose.
• Alkaline phosphatase level.
• Calcium, phosphorus level.
• iPTH
• SGOT, SGPT.
• Complete blood count.
• ESR.
• Blood Urea.
• Serum Creatinine:(modified rate Jaffemethod).
• Measurement of glomerular filtration rate (GFR) by:
•Measurement of glomerular filtration rate (GFR) by:
Modification of Diet in Renal Disease (MDRD):
eGFR= 186 X s.Cr –1.154 (mg/dl) X age–0.203(years).
X 1.212 (if African American).
X 0.742 (if female)
• hs CRP
• GGT
• Bone biopsy for patient who face criteria for biopsy (low
PTH level,low ALP)
The results of the present study revealed the following:
Significant correlation between presence of inflammatory biomarkers (hs CRP ) and clinical and laboratory finding of CKD-MBD.as we find correlation between high levels of alkaline phosphatase level with normal GGT in comparison with level of hs CRP in CKD patients ,also significant correlation between parathyroid hormone, phosphate level with hs CRP while calcium level showed no significance with level of hs CRP.