الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
 |  | from | 119 |  |  |
| | | from | 119 | | |
Abstract
The incidence of chronic kidney disease (CKD) is reaching an epidemic proportion worldwide. The number of patients diagnosed at the early stages of CKD exceeds those reach the end-stage renal disease by more than 50-folds. Therefore, the nephrology community needs an early sensitive and reliable marker of CKD. The diagnosis of renal failure is usually suspected when serum creatinine is greater than the upper limit of the “normal” interval. However, creatinine is proved to be a late marker of CKD.
The aim of the present study was to evaluate the clinical utility of serum FGF23 as a novel specific and early marker of diagnosis and progression of renal disease in non-diabetic patients of CKD.
This study was conducted at Ain Shams Specialized Hospital (ASUSH) and involved known and diagnosed CKD patients who were having follow up at dialysis inpatient and outpatient clinics. All participants in the study were not diabetic. An informed consent was obtained from every patient. Participants (150 males) were divided into two different groups; group A (control group): this group included 30 of healthy male people. group B: this group contained 120 male patients with CKD who were classified according to the eGFR into the following stages; Stage 2 included 30 patients (eGFR 60-89 mL/min), Stage 3 included 30 CKD patients (eGFR 30-59 mL/min), Stage 4 included 30 CKD patients (eGFR 15-29 mL/min), and Stage 5 included 30 CKD patients (eGFR < 15 mL/min).
Glomerular filtration rate was used as a criterion for the classification of patients of CKD. There was a significant depression in GFR in stages 2, 3, 4 and 5 compared to control. Patients in stage 2 of CKD did not show any significant difference in serum BUN or creatinine levels. With the progression of CKD from stage 2 to stage 5, there was a linear increase in the serum BUN and creatinine levels. There was a significant decrease in serum albumin in all CKD stages when compared with control. No significant changes in albumin were recorded between each pair of the successive stages.
Patients in stage 5 of CKD did not show any significant difference in serum Ca2+ level compared to control. There was a significant decrease in serum Ca2+ level in stages 2, 3 and 4 compared to control group. No significant changes in calcium level were recorded between each pair of the successive stages. Patients in stages 2, 3 and 4 of CKD did not show any significant difference in serum phosphorus level compared to the control group. Only patients in CKD stage 5 showed a significant elevation in serum phosphorus level as compared to control. The % of change in stage 4 was 21% which did not achieve a statistical significance, the change in stage 5 was 44% from control. On comparing different stages, significant changes were recorded between each pair of the following stages; (3 and 4) and (4 and 5). With the progression of CKD from stage 2 to 5, there was a linear increase in serum PTH level. However, the elevations in stages 2 and 3 did not achieve a statistical significance compared to control. The elevation in serum level of PTH in stages 4 and 5 was significant compared to control. There were significant changes between stages (3 and 4) and between (4 and 5).
There was a significant elevation in serum CK activity in stages 2, 3, 4 and 5 of CKD when compared with control. On comparing different stages, significant changes were recorded between each pair of the following stages; (3 and 4), and (4 and 5). Patients in stage 2 of CKD did not show any significant difference in serum LDH activity compared to control. There was a significant elevation in serum LDH activity in stages 3, 4 and 5 as compared to control. There was a significant difference between stages 2 and 3. There was a significant elevation in serum CRP level in stages 4 and 5 compared to control. Patients in stages 2 and 3 did not show any significant difference in CRP as compared to control. On comparing different stages, significant changes were recorded between each pair of the following stages; (3 and 4) and (4 and 5). With the progression of CKD stages from stage 2 to 5, there was a significant linear increase in serum TNF- level. On comparing different stages, significant changes were recorded between each pair of the following stages; (2 and 3), (3 and 4) and (4 and 5).
Patients in stages 2 and 3 of the CKD did not show any significant difference in serum ALT or AST activity as compared to control. There was a significant elevation in the activity of both aminotransferases in stages 4 and 5 compared to control. For ALT and AST, no significant changes were recorded between any stage and its precedent stage. Patients in stages 2 and 5 of CKD did not show any significant difference in serum testosterone level. Serum testosterone level was significantly reduced in stages 3 and 4 as compared to control. No significant changes were recorded between each pair of the groups. With the progression of CKD stages from stage 2 to 5, there was a linear increase in serum FGF23 level. There was a significant elevation in serum FGF23 level in all stages compared to control. The change in stage 2 was " ~ " 91% from control and the change was 313%, 549% and 1067% for stages 3, 4, and 5, respectively. On comparing different stages, significant changes were recorded between each pair of the following stages; (2 and 3), (3 and 4) and (4 and 5).
7. Conclusion
The progression of CKD in the current study was associated with elevations in BUN, creatinine, PTH, phosphorus, CK, LDH, CRP, TNF-, ALT, and AST, and reductions in GFR, albumin, calcium, and testosterone. However, FGF23 was the most sensitive indicator in the diagnosis and staging of CKD. PTH and phosphorus were elevated only in late stages 4 and 5. Similarly, creatinine and urea were elevated in late stages in addition to their low specificity. Therefore, FGF23 could be used as an early non-invasive indicator in the diagnosis of CKD, staging, and prognosis of the disease in response to certain medications.