Study of the NAFLD in CKD Patients Using Fibroscan Study Clinical Trial
Official title:
Prevalence of Non-alcoholic Fatty Liver Disease in Patients With Chronic Kidney Disease in Assiut University Hospitals
The aim of our study is:
1. The early detection of NAFLD in CKD patients with different stages (stage I to IV) to
avoid progression to liver fibrosis.
2. Evaluation of the relationship between the severity of fatty liver in NAFLD assessed by
liver enzymes, biochemical markers, ultrasonography and grades of Fibroscan with CKD
staging, eGFR and proteinuria.
Chronic kidney disease (CKD) is defined as presence of reduced glomerular filtration rate
(GFR) < 60 ml/min/ 1.73 m2 and/or evidence of kidney damage (usually indicated by albuminuria
or proteinuria) for > 3 months or more irrespective of cause . CKD stages are classified
according to the National Kidney Foundation in to five stages according to estimated GFR .
The prevalence of CKD is continuously rising in concert with the rising epidemic of its risk
factors including ageing, diabetes, obesity, metabolic syndrome, smoking, and hypertension .
Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases in
Western countries. It encompasses a spectrum of conditions with lipid deposition in
hepatocytes, ranging from simple steatosis to non-alcoholic steatohepatitis (NASH).
It is defined as fatty liver with inflammation and hepatocelullar injury with or without
fibrosis, advanced fibrosis and cirrhosis. Metabolic syndrome with its clinical traits is
highly prevalent in patients with NAFLD .
Preliminary data suggest an association between CKD and NAFLD .reported that the prevalence
of CKD was significantly higher in patients with NASH compared to patients without NASH.
Moreover, Yassui k documented the presence of moderately decreased eGFR and high frequency of
micro-albuminuria in patients with biopsy proven NASH.
The diagnosis of NAFLD/NASH is based on the gold standard of liver biopsy or less reliably on
serum liver enzymes or ultrasound imaging. However, liver biopsy has its limitations: apart
from being an invasive procedure, connected with serious complications .
Many non-invasive procedures have been intensively applied to detect hepatic steatosis and
fibrosis. The Controlled Attenuation Parameter (CAP) can using transient elastography (TE)
(Fibroscan®) permits to efficiently separate different grades of severity of steatosis. CAP
is based on the properties of ultrasonic signals acquired by the Fibroscan®. It allows to
simultaneously measure liver stiffness and CAP in the same liver volume.
The volume used for the measurement by the Fibroscan® is 200 times larger than that of a
liver biopsy specimen. Therefore the Fibroscan® is used more and more in clinical practice .
Many biochemical markers can be used for diagnosis of NAFLD such as tissue inhibitor of
metalloproteinase 1 (TIMP1), aminoterminal peptide of procollagen III (P3NP) .
Up till now, the relationship between NAFLD and CKD is still poorly understood and under
discussed.
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