الفهرس 
Introduction & RationaleOnly 14 pages are availabe for public view
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Abstract
Secondary hyperparathyroidism (SHPT) is a common complication of chronic kidney disease (CKD) that is associated with increased mortality. Hyperphosphatemia, hypocalcemia, and a progressive decline in calcitriol levels all stimulate parathyroid hormone (PTH) secretion and have long been known to contribute to the pathogenesis of SHPT.
Fibroblast growth factor 23 (FGF-23), a hormone that is secreted by osteoblasts, is an important regulator of phosphorus and vitamin D metabolism. In patients with kidney disease, normal serum phosphate levels are maintained despite a declining nephron mass, in part by progressive ”secondary” increases in FGF-23 levels, which stimulate greater excretion of phosphate through the remaining nephrons and limit the absorption of dietary phosphorus by inhibiting the synthesis of 1,25-dihydroxyvitamin D. In end-stage renal disease (ESRD), FGF23 concentrations are therefore markedly increased when compared with healthy individuals .Elevated FGF23 in CKD has been proposed to play a role in the development of secondary hyperparathyroidism.
Our study assessed the level of Serum fibroblast growth factor-23 in ESRD patient on regular haemodialysis and evaluated the relation between Serum fibroblast growth factor-23 and hyperparathyroidism in end stage renal disease patient on regular haemodialysis. A total of 49 patients with ESRD on regular haemodialysis (3 times per week) in Suez Canal University Hospital have been included in the study. A control group of age and sex matched 10 health individuals with normal kidney function and normal PTH have been included to derive reference range and for comparative purposes.
The studied patients were in age group ranging from 12 – 75 years with mean age 34.69 years. Most of the studied patients (32.7%) were in age group 10 – 25 years and equal percentages were in age group 25 – 40 years.
Most of our studied patients have FGF-23 levels in range of 150 – 200 Ru/ml (28.6%). 4.1% of the patients showed FGF-23 serum levels over 300 Ru/ml. Average value of FGF-23 among control group was estimated to be 50.9 RU/ml, and it was estimated that all of the studied patients show higher levels than this value. Also all of the studied patients have high levels of parathormone compared to normal values.
Our results have shown that FGF-23 and PTH levels are positively correlated with statistical significance, also shows that FGF-23 has significant positive correlation with serum phosphorus and ferritin level, and that FGF-23 was significantly higher among patients on regular vitamin D supplementation intake.FGF-23 was negatively correlated with serum calcium levels.
We have found that the most common orthopedic complication that was reported among most of the studied patients was bone aches (83.7%). Only 5 patients (10.2%) have history of fractures and only 1 patient has bone deformity. We have found that patients with bone aches and fractures have significantly higher levels of both FGF-23 and PTH than patients with negative history of either bone ache or fractures.
In conclusion
We have found that FGF-23 is markedly elevated in all patients with ESRD on regular haemodialysis, and that FGF-23 has significant correlation with PTH, phosphorus and orthopedic complication as bony aches.
The measurement of serum FGF-23 levels is a promising laboratory method that can be applied in clinical practice for the treatment of patients with uremic secondary hyperparathyroidism, and FGF-23 may, in combination with other markers, offer noninvasive information for the diagnosis of skeletal mineralization defects in ESRD patients with secondary hyperparathyroidism.