الفهرس 
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Abstract
Pruritus is a common and annoying symptom in patients with
chronic kidney disease (CKD), the most recent epidemiologic data
have suggested that about 40% of patients with End-stage renal
disease complain of moderate to severe pruritus and that uremic
pruritus (UP) has a major clinical effect, being associated strongly
with impaired sleep, depression,poor quality of life, and increased
mortality .
Multiple hypotheses have been postulated for the
etiopathogenesis of uremic pruritus. Among them some evidence
supported a major role of an immune hypothesis, based on the
findings that serum levels of high-sensitivity C-reactive protein
(hsCRP) and some inflammatory cytokines, such as interleukin IL-2
and IL-6, were elevated in patients with uremic pruritus,However, a
consensus has not yet been reached among these studies, and uremic
pruritus remains poorly characterized.
IL-31 is a cytokine derived from T-cell, It has been found to
induce severe dermatitis and pruritus in transgenic mice, signaling
through a heterodimeric receptor formed of IL-31 receptor A and
oncostatin M receptor, which is expressed on keratinocytes and
epithelial cells, IL-31 has been demonstrated to play a direct
immunomodulatory properties in vitro and might be involved in the
recruitment of polymorphonuclear cells, T cells, and monocytes to the
skin.
In human subjects, increased expression of IL-31 is associated
with the induction and persistence of pruritus and chronic skin
inflammation, such as atopic dermatitis and allergic contact dermatitis.
The expression of IL-31 in patients with CKD remains unclear,
and the association between IL-31 and UP has not yet been reported.
The aim of this work was to evaluate the possible role of
Interleukin-31 in the pathogenesis of uremic pruritus in chronic
kidney disease patients with and without hemodialysis and its relation
to severity of pruritus.
This case control study was carried out on CKD patients
recruited from the outpatient clinic and dialysis unit of nephrology
department, menoufia university hospitals. This study was conducted
on 88 CKD patients. these patients were divided into 4 groups, Group
1 included 22 patients with CKD suffering from pruritus of different
degrees ,group 2 included 22 patients with CKD not suffering from
pruritus (control group) ,group 3 included 22 patients End Stage
Renal Disease ( ESRD) on maintenance hemodialysis suffering from
pruritus of different degrees ,group 4 included 22 patients (ESRD) on
maintenance hemodialysis not suffering from pruritus (control group).
All patients were free from dermatological diseases and other
systemic diseases causing pruritus, the study was approved by the
ethical committee of medical research of faculty of medicine,
menoufia university. Written informed consent was obtained from all
participants before the study. All studied cases were subjected to
complete history taking, clinical and dermatological examination,
venus blood samples (3 ml) were taken after12hours overnight fasting
and sent to biochemistry department faculty of medicine, menoufia
university for measuring IL-31 serum levels by enzyme linked
immunosorbent assay (ELISA).
According to the comparison between IL-31 serum level in
chronic kidney disease patients with and without pruritus our result
showed that IL-31 serum level was higher in uremic pruritus patients
in group 1 mean (SD) 8.59 (11.71) compared with controls 3.54 (4.99)
in group 2 however it was not statistically significance and also IL-31
serum level was higher in uremic pruritus patients in group 3 mean
(SD) 6.44 (7.88) compared with controls 3.58 (3.84) in group 4
however it was not statistically significance with p-value = 0.199 by
using Mann Whitney test. The result also showed no significant
difference of IL-31 levels according to severity of uremic pruritus
with p-value, 0.061 in group 1 and 0.199 in group 3 by using mann
Whitney test.
In the current study there is a statistically significant difference
between serum calcium levels in hemodialysis patient with pruritus
(group 3) than those without pruritus. This is in accordance with
several studies reported in haemodialysis patients indicating a
significant relationship of uremic pruritus with higher serum calcium
level .
The elevated calcium level can be explained by reduced calcium
excretion in end stage renal disease, vitamin D supplementation and
use of calcium containing phosphorus binders, such as calcium
carbonate or calcium acetate would facilitate itch through deposition
in the epidermal layers producing a peripheral sensitization to itch .
from this work, we can conclude that there is apparent
increased serum level of the IL 31 in the studied group appeared by an
increased mean and standard deviation .This may be due to the small
number of the sample, this means that evaluation of the role of
interleukin 31 in the pathogenesis of renal pruritus require follow-up
studies on a larger group of patients.