الفهرس 
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Abstract
A healthy strong bone needs a healthy functioning kidneys. With impaired kidney function, a disturbance of calcium and phosphorus levels in the serum starts to appear. In addition to abnormal parathyroid hormone degradation and enhanced secretion and also decrease activation of 1.25 dihydroxy-chole calciferol in the proximal nephron, thus deficiency of renal function will affect the bone of the diseased patients.
Renal bone disease can be diagnosed by several non-invasive manauvers rather than the highly painful and invasive bone histomorphometric study that still the golden standard for diagnosis of ROD.
Certain specific and sensetive serum biochemical tests could monitor bone turnover in uremia.
PTH, alkaline phosphatase and osteocalcin have been proposed as serum bio chemical markers of bone formation and of bone resorption.
Aim of this study:
* Detection of bone changes in patients with chronic impaired renal function as well as in non-dialyzed patients with advanced chronic renal failure.
* Correlation between the severity of bone changes as diagnosed by laboratory, radio-nuclear and bone densitometric studies with both creatinine clearance and with possible etiology of the underlying renal disease.
Subjects and Methods:
This study was done including 30 chronic renal failure patients in the pre-dialysis period and another 15 normal subjects as control group C.
The patients were classified according to the degree of renal affection into:-
Group (A): 15 patients with mild to moderate renal impairment (Stage III and IV CKD)
Group (B): 15 patients with advanced renal disese (Stage V CKD).
Also the patients were classified according to etiology of renal disease into:-
Group (G): 18 patients with glomerular renal disease.
Group (T): 12 patients with tubulo-interstatial renal disease.
All the studied subjects were subjected to the following investigations
1- Labotory investigations: peripheral haemogram, complete liver function tests, kidney function tests, serum calcium and phosphorus, serum PTH, and serum osteocalcin.
2- Bone densitometric Study.
3- Radionucleide studies.
Results:
The following results were obtained:-
1- Laboratory results:-
- Hemoglobin concentrations and RBCs counts:-
Statictically highly significant reduction in all groups of patients compared to control group and significant reduction in group (B) compared group (A) and in group (G) compared to group (T).
- Other indices of hemograms showd insignificant changes among all groups.
- Blood urea and serum creatinine and creatinine Clearance: there was highly significant reduction in all groups of patients when compared to control one, and significant reduction in group (B) when compared to group (A).
- Serum Calcium: There was significant reduction in all groups of patients compared to group (C) and significant redction in group (B) when compared to group (A).
- Serum phosphorus: there was significant elevation in all groups of patients compared to control group and in group (B) when compard to group (A).
- PTH: there was highly significant elevation in all groups of patients compared to control group and in group (B) compared to group (A) and in group (G) compared to group (T).
- Osteocalcin: there was highly significant elevation in all groups of patients compared to control group and in group (B) compared to group (A) and in group (G) compared to group (T).
2- Bone Mineral density: estimated by quantitative ultra-sound measurements where there was significant reduction in BMD in group (B) compared to control group, and T-score values there was significant reduction in all groups of patients compared to control group and in group (B) compared to group (A).
3- Radionucleide Studies:
- Renal scan: to estimate the GFR showed insignificant changes between GFR values estimated by radionucleide assay and values estimated by laboratory measures.
- Bone scan: there was statistically significant percentage of occurance of bone changes more in group (B) as compared to percentage of occurance in group (A) and in group (T) more than group (G).
Conclusion
- Bone changes in patients with early stages of chronic kidney disease could be detected non-invasively by laboratory, bone densometry and radionuclear studies.
- The severity of these changes could be correlated with both creatinine clearance and with possible etiology of underlying renal disease.