ABSTRACT
Ghrelin is an orexigenic gastric hormone that stimulates food intake. Increased levels of ghrelin are often found in disease states associated with wasting. Wasting is a common phenomenon in end stage renal disease patients in whom elevated ghrelin levels have been reported. This work aimed to study the levels of plasma ghrelin hormone, serum growth hormone and serum leptin in a group of patients with chronic renal failure on conservative treatment as well as in a group of patients of end stage renal failure on regular haemodialysis and the relation of these hormones to the nutritional status in either group. A total number of ninety subjects were included in this study and they were classified into three main groups. Group I comprised twenty healthy subjects [10 males and 10 females] as control group, age ranged from 19- 59 years with mean and SD of 40 +/- 11.7 years. Group II comprised thirty five patients [20 males and 15 females] with chronic renal failure on conservative treatment, age ranged between 17- 69 years with mean +/- SD of 43.25 +/- 16.3 years. Group III comprised thirty five patients [20 males and 15 females] with end stage renal disease with their age ranged between 18- 7 0 years with the mean +/- SD of 47.57 +/- 11.5 years, maintained on regular haemodialysis. Plasma ghrelin, serum growth hormone, serum leptin, nutritional status [through subjective global assessment and body mass index] and creatinine clearance were evaluated. The plasma ghrelin, serum growth hormone and serum leptin levels were markedly and significantly elevated in chronic kidney disease either on conservative management or on regular haemodialysis [P< 0.001, P< 0.001 and P< 0.001] but there were negative correlations when comparing serum leptin level with plasma ghrelin and serum growth hormone levels [P< 0.001] and [P< 0.001]. The nutritional status of the patient which was assessed by the body mass index and subjective global assessment was found to correlate positively with creatinine clearance and serum leptin level [P< 0.05 and P< 0.05] but negatively with plasma ghrelin and serum growth hormone levels [P< 0.001 and P< 0.001]. The subjective global assessment as well as hormonal profile including the plasma ghrelin, serum leptin and serum growth hormone levels are all not only good markers of nutritional status in chronic renal failure patients but also good indicators about renal function deterioration
ABSTRACT
The aim of this study was to investigate the effects of inhalational vs intravenous anaesthesia on cytokines and hormones production in response to major surgery. Twenty patients ASA I and II were randomly allocated to receive either halothane-N0[2] [Inhalation group] or propofol-fentanyl [I.V. group]. Blood samples for cytokines include interleukin-1 beta [IL-1 beta], interleukin-2 [IL-2], interleukin-6 [IL-6] and interferon-lamda [IFN-lamda] and for hormones, cortisol and prolactin concentrations were obtained at intervals; before induction, end of surgery and 24 hours postoperatively. No significant changes were observed in interleukins or hormones concentrations between the two groups before induction of anaesthesia IL-1 beta increased by the end of surgery with no difference between both groups. IL-2 decreased significantly in I.V. group by end of surgery as compared with inhalational group. lL-6 increased significantly in inhalational group and still high 24 h. postoperatively. IFN-lamda decreased significantly by end of surgery in both groups. Cortisol level increased significantly in inhalational group more than in I.V. group by the end of surgery and no significant difference 24 h. postoperatively. Prolactin concentration increased but no significant difference between the two groups throughout the study period. We concluded that I.V. anaesthesia with propofol-fentanyl minimise rise of IL-6 and suppresses release of IL-2 and plasma concentration of cortisol as compared with halothaneNO[2] anaesthesia which increase secretion of IL-2, IL-6 and cortisol concentrations