الفهرس 
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Abstract
End stage renal disease (ESRD) is a world-wide serious health and economic issue with an increasing incidence and prevalence. The term chronic renal failure usually means ESRD with a decline in glomerular filtration rate (GFR) below 0.25ml/sec. The term of renal failure or renal insufficiency is generally applied to impairment in the glomerular filtration rate (GFR), since the GFR is equel to the sum of the filtration rates in all of the functioning nepherons, the total GFR is assumed to be the index of the functioning renal mass.
End stage renal disease is characterized by a gradual reduction in the number of functional nephrons. When only less than 10% of renal function remains. There are many possible causes: chronic immune glomerulopathy, hypertensive nepherosclerosis, chronic tubulointerstitial disease, metabolic diseases (e.g., diabetes mellitus), congenital and hereditary renal processes (e.g., renal polycystic disease).
End stage renal disease affects both hypothalamus pituitary–thyroid axis and thyroid hormone peripheral metabolism, uremia influences the function and size of the thyroid. End stage renal disease patients have an increased thyroid volume compared with subjects with normal renal function and a higher prevalence of goiter mainly in women. Also, thyroid nodules and thyroid carcinoma are more common in ESRD patients than in the general population. Serum TSH concentrations are usually normal or elevated in ESRD.
Total T3 and T4 concentrations are usually normal or low in patients with ESRD, the reduction in T3 levels (low T3 syndrome) is the most frequently observed thyroid alteration in these patients. This reduction in T3 concentrations has been linked to a decrease in the peripheral synthesis of T3 from T4. chronic metabolic acidosis associated with the ESRD may contribute in this effect.
These patients showed an association between low serum values of T3 with inflammation markers (elevated level of interleukin-6). The lower concentration of T3 the greater degree of inflammation. A number of factors prevalent in patients with ESRD, such as hypertention, adiposity, insulin resistance, fluid overload and persistent infections associated with elevated IL-6. In addition, reduced renal function directly or indirectly related to IL-6 elevation. Also, factors associated with the dialysis procedure such as, bioincompatibility of dialyzer membranes and dialysis solutions may stimulate IL-6 production.
This study aims to investigate Pituitary thyroid axis functions (T3, T4 and TSH) in ESRD patients and its relation with serum IL-6. Also, estimate if the thyroid hormones can be used as predisposing risk factors and morbidity indicator among ESRD patients.
In this study, the blood samples of ESRD patients and healthy individuals were collected to:
1. Measure the biochemical parameters of ESRD patients and control subjects, such as : renal functions parameters (creatinine, blood urea nitrogen” BUN” and uric acid), electrolytes (sodium, potassium, calcium and phosphorus), liver functions tests (Total protein ”TP”) albumin, alkaline phosphates (ALP) enzyme ,Total bilirubin (TB), alanine aminotransferase (ALT) enzyme and asparate aminotransferase (AST) enzyme, and hemoglobin level.
2. Detect the levels of total triiodothyronine hormone (tT3), total thyroxin hormone (tT4) and thyroid stimulating- hormone (TSH) in ESRD patients and control subjects.
3. Determination of IL-6 level in ESRD patients and control subjects.
In the studied subjects (ESRD patients and control subjects) demonstrated that:
1. There were significant differences between ESRD cases and healthy persons in biochemical parameters (p>0.001).
2. Level of tT3 was significantly lower in ESRD patients than in the control subjects (p>0.001).
3. Total thyroxin level (tT4) was slightly low in ESRD patients as compared with control subjects(p=0.01)
4. There was no significant in TSH hormone in ESRD patients when compared with control subjects.
5. Level of IL-6 was significantly higher in ESRD patients than in control subjects (p>0.001).
6. In ESRD patients. Concentration of serum interleukin-6 (IL-6) revealed high significant negative correlation (p< 0.05) with total triiodothyronine hormone (tT3).
7. There was mild significant negative correlation (p<0.05) between IL-6 and total thyroxin hormone (tT4) in ESRD patients.
8. There was no significant correlation between (IL-6) and thyroid stimulating hormone (TSH) in ESRD patients (P<0.05).
from this study we conclude that:
Most ESRD patients are associated with alteration in circulating thyroid hormone without underlying thyroid disorder, this syndrome known as non-thyroidal illness syndrome (NTIs). Usually total T3 and T4 levels were reduced; this reduction is associated with elevated inflammation and cytokine production as (IL-6). This study shows that thyroid hormonal changes are induced by pathology and dialysis treatment.
from this study we can recommend that:
• Total triiodothyronine (tT3) hormone can be used as predicting and prognostic factor to avoid any complications leading to mortality in end stage renal disease.
• Continuous monitoring of thyroid profile for early treatment of developed hypothyroidism to prevent occurrence of co-morbidities with ESRD patients by thyroxin therapy.
• More studies including a large number of patients should be done to clarify or refute our findings.