الفهرس 
Chapter 1: chronic kidney diseasesOnly 14 pages are availabe for public view
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Abstract
The sharp rise in the prevalence of chronic kidney disease that parallels an increase in the prevalence of obesity in the recent years is a cause for great concern.
Obesity is a significant risk factor for increased mortality and morbidity, and the burden is growing. In 2013, being overweight or obese accounted for 4.4 million deaths worldwide – an increase of 63 per cent from 1990.
A growing body of evidence indicates that obesity is a potent risk factor for the development of de novo CKD and end-stage renal disease (ESRD), data also suggest that interventions targeted at reducing obesity may reverse or retard CKD progression.
A number of mechanisms have been proposed as explanations for obesity related CKD, including chronic inflammation, abnormal vascular remodeling, and renal lipo-toxicity. These routes of injury can occur in the absence of diabetes and hypertension. Perhaps the best described mechanism of obesity-induced kidney injury involves the adverse effects of increased body mass and subsequent increased glomerular filtration rate per intact nephron, i.e. functional stress.
The associated increased adiposity initiates a cascade of cellular events that leads to progressive obesity-associated diseases such as kidney disease. Recent evidence has indicated that adipose tissue produces bioactive substances that contribute to obesityrelated kidney disease.
These various effects result in specific pathologic changes in the kidneys which could underlie the higher risk of CKD seen in observational studies. These include ectopic lipid accumulation and
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increased deposition of renal sinus fat, the development of glomerular hypertension and increased glomerular permeability caused by hyperfiltration-related glomerular filtration barrier injury, and ultimately the development of glomerulomegaly, and focal or segmental glomerulosclerosis.
The lack of community-based screening programs for CKD results in patient detection at advanced stages. Hence, this study was designed to estimate prevalence of CKD in obese patients, and for early detection of undetected kidney disease in obese patients.
This study was designed to estimate prevalence of CKD in obese patients, and for early detection of undetected kidney disease in obese patients.
This cross-sectional study was conducted on 200 participants of obese patients, with BMI <30 kg/m2. All patients were selected from Helal hospital Health Insurance & Sheben El kom teaching hospital& Quesna Central hospital & Tala Central hospital & Birket El sabaa central hospital and the Outpatient Clinic of Internal Medicine Department of Menofia University Hospitals.
All patients included in this study were subjected to questionnaire filling which included socio – demographic data, medical history, history of nephrotoxic medications, CKD related questions, familial history of kidney disease, history of smoking and alcohol consumption. Clinical examination including general examination, anthropometric measurements, and local abdomenal examination was done. Routine laboratory investigations including CBC, Blood Glucose, Lipid Profile, HbA1C, Serum urea and serum creatinine, Urine albumin to creatinine ratio, Urinalysis, Serum
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Albumin, Serum ca, Na, K, phosphorus, uric acid, and abdominal ultrasound.
Results:
The mean age was 48.45 ± 10.62, ranged 25:67 years, 52% of them ≥ 51 years old, 57.5% of participants were female, 44% has history of renal disease, 37.5% were hypertensive patients, 20% of them were diabetic patients, 11% of them had history of kidney stones, 62% of them had history of repeated UTI, and 14.5% of them had diabetic nephropathy.
The mean weight was 101.07 ± 11.32.
The mean serum Urea was 28.20±33.72, the mean serum Creatinine was 1.95±2.55, the mean serum Albumin was 4.27±0.74, the mean Albumin creatinine ratio was 3.54±5.91, and the mean Uric acid was 6.31±1.92. 38% of participants had hyper urecemia, 29.5 % had Albuminuria 24% had high level of Serum Creatinine, 37.5 % had eGFR ≥ 90 (mL/min/1.73 m2), 32.5% had eGFR 60-89, 19 % had eGFR 30-59, and 11 % had eGFR < 30, there was a significant difference between CKD and non CKD cases regarding kidney function tests.
A significant difference presented between CKD and non CKD groups regarding obesity where in non CKD cases, 5.8% were over weight, 86.9% were obese 7.3% had severe obesity, while in CKD cases, 9.5% were over weight 65.1% were obese, and 25.4% had severe obesity.
There was a significant difference between CKD and non CKD as regards to age, where 63.3% of non CKD cases were ≤ 51 years old, 73 % of CKD cases were > 51 years old (P<.001), significant
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difference between both groups presented regarding gender where 52.6% of CKD cases and 68.3 % of non CKD cases were females.
There was a significant difference between the two groups regarding hypertension where 26.3% of non CKD cases and 38.1% of CKD cases were hypertensive. Also there was a significant difference between the two groups regarding DM where 13.9% of non CKD cases and 44.4 % of CKD cases were diabetic.
There was a significant difference between the two groups regarding history of UTI where 51.8% of non CKD cases and 84.1 % of CKD cases had history of UTI, also there was a significant difference between the two groups regarding the presence of diabetic nephropathy where 10.9% of non CKD cases and 22.2 % of CKD cases had diabetic nephropathy.
There was a significant difference between the two groups regarding family history of R.D where 43.8% of non CKD cases and 44.4 % of CKD cases had family history of renal disease.
There was a significant negative correlation between eGFR and age, SBP, DBP, HB, Hb1c, Cholesterol, Triglyceride, LDL, Ca, Po4, Na, K, Urea, Creatinine, Albumin, Albumin creatinine ratio and Uric acid.
There was a significant negative correlation between eGFR and age, SBP, DBP, HB, Hb1c, Cholesterol, Triglyceride, LDL, Ca, Po4, Na, K, Urea, Creatinine, Albumin, Albumin creatinine ratio and Uric acid.