‘’TO EVALUATE, CRP AS A MARKER FOR CHRONIC KIDNEY DISEASE PATIENTS’’
Main Article Content
Keywords
C-Reactive Protein, Chronic Kidney Disease, Diabetes Mellitus
Abstract
Background: Chronic Kidney Disease (Ckd) Encompasses A Spectrum Of Different Pathophysiologic Processes Associated With Abnormal Kidney Function, And A Progressive Decline In Glomerular Filtration Rate (Gfr). The Term Crf Applies To The Process Of Continuing Significant Irreversible Reduction In Nephron Number, And Typically Corresponds To Ckd Stages 3–5 Persistent, Low-Grade Inflammation Likely Participates In The Pathophysiology Of Both Atherosclerosis And Kidney Disease. Although High-Sensitivity C-Reactive Protein (Hscrp) Predicts Future Cardiovascular Risk And Chronic Kidney Disease (Ckd), It Is Unknown Whether Hscrp Levels Predict Adverse Renal Outcomes In Patients With Cardiovascular Disease.
Methods: We Included All Inpatients With Clinical And / Or Biochemical Evidence Of Chronic Kidney Disease, Admitted In The Hospital For Ckd And Cardiovascular Disease. Patients Who Refused To Give Consent, Critically/Terminally Ill Patients, Patients With Pre-Existing Cardiac Valvular Disease, Hiv Positive Patients, Patients Taking Immune-Suppressive Therapy, Patients On Chemo-Therapy, Acute Kidney Injury Patient Were Excluded. After Taking Institutional Ethical Clearance And Written Consent From The Patients A Cross Sectional Observational Study Was Conducted On Patients Admitted In The Hospital, Who Had Clinical And / Or Biochemical Evidence Of Chronic Kidney Disease. A Detailed Thorough History Was Taken, General Physical Examination, Systemic Examination And Routine And Specific Lab Investigations Were Done To Find Out The Underlying Aetiology, Clinical Features And Outcome Of Chronic Kidney Disease. Pro Forma I -Informed Consent Form Annexure G-Master Chart Proforma.
All The Data Analysis Was Performed Using Ibm Spss Ver. 20 Software. Frequency Distribution And Cross Tabulation Was Used To Prepare The Tables. Quantitative Variables Were Expressed As The Mean And Standard Deviation. Categorical Data Was Expressed As Percentage. Categorical Variables Were Compared By Chi-Square Test. Mean Was Compared Using One Way Anova Analysis. Prism And Microsoft Office Was Used To Prepare The Graphs. Hscrp Tests Measured During Hospitalization/Emergency Room Visits.
Results: This Prospective Observational Study Was Done In 100 Patients In Central India, To Observe Crp Levels In Ckd Patients And To Evaluate Crp As A Marker For Cardiovascular Risk, From 1st December 2019 To 31th October 2020.
In This Study Group Majority Of The Patients Were Above 30 Years Of Age. The Mean Age Of The Study Was 47.8 Years, Male: Female Incidence Was In The Ratio Of 1.85:1. There Was Significant Predominance Of Ckd In Male Patients In The Study. Patterns In The Incidence Of Kidney Disease Across Gender Were Generally Consistent, With Higher Rates Occurring In Men Than In Women. Similarly, Men Were Reported To Have Greater Rates Of Progression Of Nondiabetic Ckd For Some Specific Types Of Kidney Disease, Especially Compared With Premenopausal Women.
In Our Study Sbp And Dbp Were Raised Above The Reference Levels, Mean Sbp Were 148.2±8.81 And Mean Dbp Were 99±6.89. The Mean Level Of Urea Was 146.6±27.5 Mg/Dl. A Significant Correlation Between Serum Creatinine And Crp Levels Were Noted, Which Has Been Shown By Significant P- Value Of <0.0001 And A Significant Negative Correlation Between Crp Levels And Egfr Has Also Been Noted, Which Has Been Shown By Significant P-Value Of <0.0001. There Was An Insignificant Negative Correlation Between Serum Creatinine Levels And Haemoglobin Levels, Which Has Been Shown By Insignificant P-Value Of >0.05 [Mean Level Of Creatinine Was 11.6±2.7 Mg/Dl, Mean Haemoglobin Was 7.469±0.80 Mg/Dl, Hscrp Was Raised Above Reference Level, The Mean Level Hscrp Was 5.45±2.79 Mg/Dl].
The Average Egfr Was 5.45±2.79 Ml/Min/1.73m2. Most Of Patients Were Esrd Patients And Were In Stage 5 Of Ckd, With Most Common Associated Disease Being Htn (49%) Followed By Dm (26%), Whereas Ckd Alone Were 36%. In Most Of The Patients Hscrp Was Raised Above The Baseline. The Mean Levels Of Hscrp Were 5.45±2.79 Mg /Dl. In 85% Of Patients Hscrp Was Raised Above 5 Mg/Dl And In 45 % Of Subjects, Hscrp Was >5 Mg/Dl.
Conclusions: The Present Study Shows Excess Inflammation And Oxidative Stress In The Ckd Patients, As Hscrp Were Raised In 45% Of Patients Above 5 Mg/Dl Which Is Similar To The Previous Studies. Renal Insufficiency Causes A Prolonged Acute Phase Inflammatory Reaction That Is Accompanied With Elevated Inflammatory Markers Such As Hscrp, Il-6. These Inflammatory Markers Are Significantly Associated With Cardiovascular Morbidity And Mortality. Elevated Hscrp Was Associated With Subsequent Risk Of Aki And Progression Of Ckd, Irrespective Of Baseline Kidney Function
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Dr Janhvi Mishra
M.D Medicine, Junior Resident, Chirayu Medical College And Hospital, Bhopal. 462030
Dr. Priyanka Singh
Md Medicine, Senior Resident, Department Of Medicine, Nscb, Mch, Jabalpur
Dr Kshama Shrivastava
Demonstrator Department Of Pathology, Bundelkhand Medical College Sagar, 471001