Abstract:
Introduction: Chronic kidney disease is associated with increased morbidity and mortality in cardiovascular disease. Apart from traditional risk factors, chronic inflammation, and increased left-ventricular wall tension related to hypervolemia are important in cardiovascular disease development in renal patients. B-type natriuretic peptide (BNP) is a cardiac neurohormone specifically secreted by cardiac ventricles in response to volume expansion and pressure overload. High sensitivity C-reactive (hsCRP) have been found to reflect chronic inflammation and significantly elevated in hemodialysis patients. Aim of the work: To assess the relationship between left ventricular filling pressure (using plasma BNP levels) and inflammation (using plasma hsCRP levels) in patients with chronic renal failure and their relationship with renal echogenisity detected by ultrasonography. Patients and methods: Plasma BNP and hs CRP were measured on the same day in 38 pre-dialysis patients. Patients were classified into 5 groups according to ultrasonographic renal echogenisity into Group 1(no=3) with grade 0, group 2 (no=2) with grade I, group 3 (no=15) with grade II, group 4 (no=14) with grade III renal echogenisity and group 5 (no=4) with complete loss of the medulla and cortex of the kidney. Result: Plasma levels of BNP and hsCRP were significantly higher in patients with chronic renal failure in comparison with controls (274.3±97.1 pg/ml versus 33.7±8.0 pg/ml and 11.4±3.9 mg/L versus 2.7±1.0 mg/L respectively P <0.0001 for each). Comparing plasma levels of BNP and hsCRP with ultrasonograghic renal echogenisity, which reflect severity of renal disease, showed that the plasma levels of BNP were 104.7±15.0 pg/ml, 148.0±67.9 pg/ml, 248.5±72.0 pg/ml, 310.1±39.2 pg/ml and 436.0±10.0 pg/ml in the five groups of patients respectively and hsCRP were 4.7±0.6 mg/L, 5.5±0.7 mg/L, 10.3±3.2 mg/L, 13.6±1.8 mg/L and 16.0±0.8 mg/L in the same previous groups respectively. It was clear that the plasma levels of both biomarkers were significantly higher in patients with more severe renal affection (P< 0.0001 for each). There was also, highly significant positive correlation between plasma levels of BNP and hsCRP in all groups of patients (r= 0.9, P<0.0001) and significant negative correlation between both markers and serum albumin (r=-0.4, P<0.001 and r=-0.5, P <0.0001 respectively) and significant negative correlation between both markers and hemoglobin levels (r=-0.8, P< 0.0001 and r=-0.8, P< 0.0001 respectively).Conclusion: The present results suggest a link between left ventricular pressure and inflammation in patients with chronic renal failure. The importance of strict volume
control in these patients, in order to reduce left ventricular pressure and therefore inflammation, should be considered. Both BNP and hs CRP could provide complementary diagnostic and prognostic information regarding future cardiovascular disorders in renal patients.