الفهرس | Only 14 pages are availabe for public view |
Abstract FGF23 is free circulating endocrine hormone which Secreted by osteocytes. FGF23 affect phosphate metabolism mainly as it inhibits renal tubular phosphat reabsorption by suppressing the expression of luminal sodium– phosphate co-transporters (NaPi). Increased FGF23 is independently associated with arterial stiffness, endothelial dysfunction and increased ventricular mass through direct activation of GF23 receptor present in cardiac tissue and this action is Koltho independent because Koltho co receptor not expressed in myocardial cell After renal transplantation the residual FGF23 activity may also contribute to early post-transplant hypophosphatemia, which could in turn play a role in the pathogenesis of post-transplant bone disease. Post-transplantation hypophosphataemia can have a detrimental effect on bone mineralization and might contribute to impaired osteoblast genesis and early osteoblast apoptosis, which further contributes to posttransplantation osteoporosis.Data from bone biopsies obtained from renal transplant recipients after transplantation have shown that serum phosphate levels are lower in patients with early osteoblast apoptosis, with serum phosphate levels correlating positively with osteoblast number and correlating negatively with the number of apoptotic osteoblasts. Also high FGF-23 levels were associated with a reduction in BMD in the lumbar spine and total hip regions during the first year post-transplantation. As a result disorders of FGF-23 excess are characterized by hypophosphatemia with increased renal phosphate wasting, decreased production of 1, 25(OH) 2D, elevated parathyroid hormone and rickets ⁄ osteomalacia after renal transplantation. In our study, Patients on dialysis had higher levels of FGF23, phosphorous, PTH and low levels of Calcium in compare with preemptive patient before renal transplantation. Also there was a significant decline in the level of creatinine, urea, K, and hemoglobin after renal transplantation in both group.Also in our study Circulating FGF23 values declined rapidly in all patients with a functioning allograft, with (p value <0.001). Also In our study, mean iPTH levels decreased sharply at 7 day post transplantation in both group with (p value <0.001) in dialysis group & also with (p value <0.001) in preemptive group. Also In our study mean phosphorus levels decreased at 7 day post transplantation in both group with statistical significance (5.6±1.2to 2.8±0.5) in dialysis patient. Also In our study serum calcium level increased with statistical significance in preemptive group. The suggest further Studies on FGF23 function and regulation will help to establish a more rational approach for the management of the mineral and bone disorders. |