الفهرس 
Introduction and Aim of The WorkOnly 14 pages are availabe for public view
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Abstract
Renal osteodystrophy is the term used to describe the skeletal complications of end stage renal disease. It is a multifactorial disorder of bone remodeling. Secondary hyperparathyroidism and 1, 25 dihydroxyvitamine D deficiency are the major contributing factors to renal osteodystrophy. Various biochemical markers have been evaluated in dialysis patients for the diagnosis of renal osteodystrophy (ROD). However, their value in predialysis patients with endstage renal failure (ESRF) is not yet clear. This study is a trial to find a method rather than bone biopsy (the best diagnostic tool) for diagnosis of renal osteodystrophy that occur as a result of chronic renal failure. The present study was conducted on 65 patients suffering from chronic renal failure of different etiology. Patients were selected randomly from inpatients of internal medicine departments of Mansoura University. The patients were grouped into three main groups; dialysis, conservative and hepatorenal groups. In addition, 10 healthy subjects act as control group. Each subject (patient and control) was subjected to the following: full history taking, clinical examination, routine laboratory investigations, (serum creatinine, calcium, phosphorus, alkaline phosphatase), plasma PTH, <U+00DF>2m and plain Xray hand. The present study reported the following results: Bone aches and fractures are more common in dialysis group than other studied groups. Also, patients unable to walk are more common in dialysis group than conservative or hepatorenal group. It is noted that there is significant decrease in albumin, Hb and platelets count in all studied groups (dialysis, conservative and hepatorenal) when compared to normal control group while there is significant increase in creatinine and fasting plasma glucose level when compared to normal control group. There is significant decrease in serum calcium level in all studied groups when compared to normal control group while there is significant increase in serum phosphorus, alkaline phosphatase, plasma PTH and <U+00DF>2m levels in dialysis, conservative, hepatorenal and whole patient groups when compared to the normal control. There is significant decrease in serum calcium level in patients suffering from bone aches and patients unable to walk than those without aches or those able to walk. There is significant increase in serum phosphorus, alkaline phosphatase, plasma PTH and plasma <U+00DF>2m in the same patient group compared to other group. Radiological findings of ROD in the current study included chondrocalcinosis of the triangular fibrocartilage, resorption of the distal tufts, subperiosteal resorption and decreased bone density are much higher in dialysis group than in other studied groups. Serum calcium level is significantly decreased in patients with these radiological findings than those without. On the other hand, other markers (phosphorus, alkaline phosphatase, PTH and <U+00DF>2m) are significantly increased. There is significant positive correlation between serum creatinin and plasma <U+00DF>2m in both dialysis and whole patient groups while there is significant negative correlation between calcium and creatinin in dialysis group. Conclusion: Renal osteodystrophy is a dilemma that needs combination of serum markers for diagnosis besides radiological investigations. Renal osteodystrophy is much obvious among CRF patients especially dialysis. PTH and Beta 2 microglobulin levels increase in chronic renal failure patients specially those with renal osteodystrophy. Beta 2 microglobulin serum level in combination with other markers may help in diagnosis renal osteodystrophy. Clinical and radiological manifestations of renal osteodystrophy are not pronounced in hepatorenal syndrome as well as serum level of Beta 2 microglobulin is not significantly elevated.