Introduction:Secondary hyperparathyroidism (SHPT) is an insidious disease that develops early in the course of chronic kidney disease (CKD) and increases in severity as the glomerular filtration rate deteriorates. Recent studies have identified fibroblast growth factor-23 (FGF23) as a new protein with phosphaturic activity. It is mainly secreted by osteoblasts and is now considered the most important factor for regulation of phosphorus homeostasis. It is not yet proven if there is any direct relation between parathyroid hormone (PTH) and FGF23. The present study aims to evaluate the relation between serum FGF23, phosphorus, and PTH in end-stage renal disease in patients with SHPT on regular hemodialysis.Materials and Methods:Forty-six consecutive CKD adult patients (case group) and 20 healthy adults (control group) were included in the study. All patients had SHPT and were on regular hemodialysis. Both groups were subjected to full medical history, clinical examination and biochemical studies. Serum phosphorus, calcium, ferritin, hemoglobin level, blood urea, creatinine, PTH, and FGF23 were analyzed.Results:Levels of FGF23 were significantly higher in the case group in comparison with those in the control group, viz., 4-fold, and positively correlated with PTH. Phosphorus levels in the case group were significantly high in spite of the increasing levels of FGF23. Both PTH and FGF23 were positively correlated with phosphorus and negatively with hemoglobin levels.Conclusion:SHPT and FGF23 may have a partial role in the development of anemia in patients with CKD. FGF23 could be a central factor in the pathogenesis of SHPT. Its role in controlling hyperphosphatemia in CKD is vague.
Background: Pregnancy is a physiological state in which significant changes in thyroid function occur. Several factors contribute to these changes. These factors could contribute to thyroid dysfunction during pregnancy especially when a deficiency of iodine intake exists and when thyroid reserve is not sufficient. Aim: To study thyroid functions in pregnant women avoiding maternal and fetal complications associated with thyroid dysfunctions. Materials and Methods: A cross-sectional study was carried out on 100 pregnant women attending Obstetrics Outpatient Clinic in Suez-Canal University Hospitals were invited to enroll in the study. At the end of study, the blood samples were assessed for free T3, free T4 and TSH. Results: This study revealed that most of the pregnant women had normal thyroid functions (51%), while subclinical hypothyroidism (39%) was the most prevalent disorder followed by clinical hypothyroidism (6%) and isolated hypothyroxinemia (4%).
Conclusion:The most prevalent pattern of thyroid dysfunction in pregnant women was subclinical hypothyroidism.
Background: Vascular calcification (VC) plays a major role in cardiovascular disease (CVD), which is one of the main causes of mortality in patients with chronic kidney disease (CKD). During the early stages of CKD, Fibroblast growth factor-23 (FGF-23) levels increase to keep serum phosphorus within the normal range. FGF23 may be associated with death and cardiovascular events in CKD patients. Aim: The study aimed at early detection of breast arterial calcification (BAC) and higher levels of FGF-23 as indicators of systemic VC in patients with different stages of CKD. Methodology: The patients were divided into 3 groups; representing stages 2, 3 & 4 of CKD women, and the 4 th group was considered as a control group. The selected participants were subjected to history taking, mammogram to detect BAC and biochemical assessment of lipid profile, Serum creatinine, Mg, P, Ca, PTH and FGF23. Results: the presence of BAC in about 81.8% of stage 4 CKD patients compared with 50% in stage 3 CKD, also in the majority of stage 4 CKD patients had high FGF-23. Receiver operator characteristic (ROC) curve analysis showed serum FGF-23 as a potential predictor of BAC (AUC=0.874) in CKD patients at the cut-off point of 77.5ng/ml (sensitivity 78%, specificity 76%). Conclusion: Although it is difficult to determine the definite stage at which the risk of VC begins but, in our study, it began late in stage 2 CKD, gradually increased prevalence through stage 3, and became significantly higher in stage 4. FGF-23 could be a good predictor of BAC in CKD
One of the clinical consequences of aberrant cytokines production in patients with end stage renal disease (ESRD) may be impaired erythropoiesis. To determine the interleukin (IL)-10 levels in ESRD patients on regular hemodialysis (HD) with good and poor response to recombinant human erythropoietin (Epo). Two groups of ESRD-HD patients were evaluated; 48 high epo HD patients and 32 low epo HD patients were evaluated for some laboratory tests and Interleukin-10 by ELISA. The production of IL-10 is decreased in HD with low epo group than high epo group 32.4 +/- 7.9 vs. 45 +/- 6.9 pg/ml (P < 0.001). IL-10 level is well correlated with CRP, ESR, Ferritin, Epo dose, and EPO/Hb ratio in ESRD-HD patients. These findings suggest that IL-10 is playing a part in affecting the response to EPO, even in the absence of any obvious infection or inflammatory condition.
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