الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Pruritus is a common and distressing symptom that affects patients with chronic kidney disease (CKD); epidemiologic data have suggested that approximately 40% of patients with end-stage renal disease experience moderate to severe pruritus and that uremic pruritus.
A large number of studies have investigated the impact of UP and its intensity on quality of life of patients with CRF who undergoing haemodialysis, sleep disturbance, anxiety and depression are associated strongly with pruritus intensity.
The pathogenesis of renal pruritus is multifactorial. Triggering factors may include uremia-related abnormalities, accumulation of uremic toxins, systemic inflammation and cutaneous xerosis. CKD with renal toxin retention has been implicated in the pathogenesis of accelerated pruritus as well.
The major renal toxins are protein-bound uremic retention solutes, especially PCS and IS. High serum IS and PCS levels have been associated with renal progression and mortality in CKD patients. IS is a protein-bound uremic toxin resulting from the metabolism of dietary tryptophan which accumulates in patients with impaired renal function, such as chronic kidney disease.
The aim of this study was to evaluate serum level of IS in chronic renal failure patients under regular haemodialysis as an etiological factor and its correlation to severity of pruritus.
This study was a cross sectional comparative study conducted in
Dermatology, Venereology and Andrology Department, Renal Dialysis
Unit, Clinical and Chemical Pathology Departments in Benha University
Hospitals.
It included (85 subjects) were selected randomly according to previously mentioned inclusion and exclusion criteria, the selected subjects were divided into two main groups (case and control group), the case group included (60 subjects) with chronic renal failure on regular haemodialysis. And then, was subdivided into two subgroups, first subgroup; group I included (30 subjects) with uremic Pruritus and second subgroup; group II included (30 subjects) without uremic Pruritus. The control group; group III included (25 subjects).
All subjects included in this study were submitted to detailed history (personal, present, past and family history), complete general examination, and complete dermatological examination. Assessment of severity of Pruritus and its intensity by using VAS scale. The impact of UP on quality of life, e.g. stress, anxiety, sleep disturbance and depression was measured by using dermatology quality of life index and important laboratory investigation including IS level, serum urea, creatinine, albumin, PTH, calcium and phosphorus were done.
On comparing both groups of patients and controls in this study, there was a significant increase of the mean serum level of IS in chronic haemodialysis patients suffering from pruritus and those without pruritus compared with controls while on comparing the two groups of patients there was significant increase of mean serum level of IS in chronic haemodialysis patients with pruritus than those without pruritus. There was a positive correlation between the serum level of IS and severity of pruritic according to VAS score with significant value.
In conclusion, the data of this study added a novel aspects to study the role of IS in uremic patients with pruritus. Pruritus was common among chronic renal failure patients on regular haemodialysis, and it was associated with an elevated total IS level. The mechanisms by which the IS level as an etiological factor in chronic pruritus is linked remain need to be more investigated. There was a significant association between QoL score and pruritus severity. Therefore, Pruritus should be regularly assessed and effectively managed in chronic renal failure patients in order to reduce associated morbidity, mortality and to improve overall QoL.