الفهرس 
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Abstract
chronic kidney disease (CKD), or chronic renal failure (CRF) as it was historically termed, includes all degrees of decreased renal function. Skeletal muscle atrophy frequently complicates the course of CKD and is associated with excess morbidity and mortality. Cardiovascular diseases have been reported to be the leading causes of death in CKD patients. chronic Kidney Disease was also reported to be associated with an increased incidence of acid-related gastrointestinal disorders. The clinical course and pathophysiology of the disease is complex, so this study aimed to evaluate the effect of CKD on the different types of muscular tissues of the body: skeletal, cardiac and smooth muscles of male Wistar albino rat.
The experiment was conducted on 20 adult male albino rats with an average weight range from 220 to 250 grams. They were divided into two groups:
group I: Control group: This group included 10 rats that received physiological saline intramuscular injection, once daily for 28 consecutive days, in a dose equivalent to that taken in group II. The rats of this group were sacrificed after 28 days of the beginning of the experiment.
group II: group of CKD: consisted of ten rats that were given Gentamicin intramuscular injection for induction of CKD. Gentamicin was given as Gentamycin sulfate, 40 mg/ml (Sandoz, Switzerland), once daily, in a dose of 80 mg/kg/day for 28 days after which the rats were sacrificed.
At the end of the experiment blood samples were collected to measure serum creatinine and blood urea nitrogen (BUN). Laparotomy was performed to collect the left kidneys, the middle third of left gastrocnemius muscle, the lateral wall of left ventricle (LV) and the gastroesophageal junction of all rats of both groups (I and II).
The kidneys, skeletal muscle, cardiac muscle and the gastroesophageal junction were processed for light microscopic examination. Very small specimens from skeletal and cardiac muscles were processed for transmission electron microscopic examination.
Serum creatinine and BUN in group II showed a significant (P<0.05) increase compared to control group.
Examination of the kidney after 28 days from the first injection of gentamicin (group II) proved the occurrence of CKD. They showed obliterated glomeruli, with significantly increased interstitial collagen fiber deposition (P<0.05) associated with tubular atrophy. Tubular epithelial simplification with luminal granular and hyaline casts were present.
The skeletal muscle of group II, 28 days after initial injection of gentamicin, showed fiber thinning and splitting with significantly decreased myocyte cross sectional area (P<0.05), significantly increased interstitial collagen fiber deposition (P<0.05). Focal loss of myofilaments with increased amount of glycogen granules, disfigurement of the regular sarcomere arrangement and nuclear abnormalities were present.
The left ventricular wall of group II, 28 days after initial injection of gentamicin, showed significantly increased thickness (P<0.05) with significantly increased interstitial collagen fiber deposition (P<0.05). Areas of myofilamentous loss, disrupted sarcolemma and vacuolations, disorganized sarcomeres and nuclear abnormalities were demonstrated.
The smooth muscle of lower esophageal sphincter of group II, 28 days after initial injection of gentamicin, showed no significant structural change of the cells in both muscularis mucosa and externa. However, neurons of the myenteric plexus showed many karyolitic and pyknotic nuclei. Non-significantly increased collagen fiber deposition in lamina propria, submucosa and in-between the smooth muscle fibers of both muscularis mucosa and externa was detected (P>0.05).
Conclusion:
It is concluded from the present study that CKD affected the three types of muscles in the body of the rat. It resulted in focal skeletal muscle atrophy, focal cardiac muscle hypertrophy and fibrosis. Although CKD showed no structural changes in the histological structure of smooth muscle of the lower part of esophagus and LES, nevertheless, it affected the myenteric plexus neurons.
Hence, it is highly recommended, in the clinical field, to draw attention to the kidney in cases presented with chronic fatigue, cardiovascular dysfunction and recurrent esophageal reflux. It also recommended to do in-depth researches to know the exact cause of such effects from the molecular point of view