الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Uremic pruritus or chronic kidney disease-associated pruritus (CKD-aP) remains a frequent and compromising symptom in patients with advanced or end-stage renal disease, strongly reducing the patient’s quality of life. More than 40% of patients undergoing hemodialysis suffer from chronic pruritus; half of them complain about generalized pruritus. The pathogenesis of UP is multifactorial. Triggering factors may include uremia-related abnormalities (particularly involving calcium, phosphorus and parathyroid hormone metabolism), accumulation of uremic toxins, systemic inflammation, cutaneous xerosis, and common co-morbidities such as diabetes mellitus and viral hepatitis. Current findings suggest that the neurophysiology of itch is similar to that of pain; this has led to the hypothesis that the two phenomena also closely interact in ESRD patients, who often also experience uremic neuropathy Osteopontin (OPN) is one of the noncollagenous proteins present in bone matrix. The presence of OPN in various organs, including those with and without matrix, and also in plasma, suggests that this molecule could act both as a structural molecule and as a humoral factor, or cytokine.The putative functions of osteopontin are bone mineralization, regulation of immune cell function, inhibition of calcification, control of tumour cell phenotype and cell activation.The aim of the present study was to assess serum level of osteopontin in patients with uremic pruritus undergoing HD, evaluation of its clinical significance and its role in the pathogenesis of UP. This study was carried out on 80 patients with ESRD undergoing hemodialysis; 40 of them suffering from Uremic Pruritus (group A) and 40 patients not suffering from it (group B). All patients selected from the hemodialysis unit of Benha University Hospitals. Informed consents were obtained from all participants.All patients included in the work were subjected to full history taking including personal history with special reference to age, sex, duration, history of renal disease and intensity of pruritus as well as other skin diseases or drug intake and complete general and cutaneous examination for exclusion of other causes of pruritus with assessment of pruritus by visual analog scale (VAS) and laboratory investigations and estimation of serum level of osteopontin in both patients groups using an ELISA technique.In this study, the leading causes of chronic renal disease were hypertension, diabetes mellitus, idiopathic, glomerulonephritis, postsurgical, polycystic kidney disease and obstructive uropathy. There were no significant difference in between the two groups regarding age or sex.In the current study, serum level of OPN was significantly higher in group A patients with UP than group B. Moreover, it was significantly correlating with the duration of HD .Moreover, serum OPN showed 95 % sensitivity and 90 % specificity in predicting pruritus in CKD patients undergoing hemodialysis when the cut off value >50 pg/ml.