Expression of Nerve Growth Factor (NGF) and its receptor (TrK A) in chronic renal failure patients with pruritus | ||||
| Sohag Medical Journal | ||||
| Article 17, Volume 21, Issue 2, July 2017, Page 149-159 PDF (254.45 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/smj.2017.41270 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
Essam E. NADA 1; Mohammed A Adly2; Mohammed A Ali3; Shimaa Shrief4
| ||||
| 1Department of Dermatology, Venereology and Andrology, Faculty of Medicine , Sohag University. | ||||
| 2Department of Histochemistry and Molecular cell biology Zoology Faculty of Science, Sohag University. | ||||
| 3Department of Dermatology, Venereology and Andrology Faculty of Medicine, Sohag University. | ||||
| 4Resident of Dermatology, Venereology and Andrology Department, Sohag Educational Hospital | ||||
| Abstract | ||||
| Background: Chronic renal failure or chronic renal disease (CRD) is a progressive loss in renal function over a period of months or years. It is differentiated from acute kidney disease in that the reduction in kidney function must be present for over 3 months. Uremic pruritus is the most common cutaneous abnormality in patients with CRF. Uraemicpruritus is unrelated to sex, age, duration, cause of dialysis, a list of unproven suggestions for pruritis include : dry skin; mast cell proliferation; Th1 cytokines; secondary hyperparathyroidism; disturbed balance between μ-opioid and κ-opioid receptors; substance P; increased skin ions Ca, Mg, PO; abnormal transmission via the spine . Nerve growth factor is a neurotropic polypeptide necessary for the survival and growth of some central neurons, as well as sensory afferent and sympathetic neurons. It has been found that in AD patients increased levels of NGF in keratinocytes and infiltrating leukocytes which were related to disease severity . Skin from patients with prurtigo nodularis also have increased presence of NGF which is primarily found in infiltrating leukocytes. Method: The present case-control study was carried out on 30 patients with CRF and uraemic pruritus on hemodialysis who were treated at Sohag Educational Hospital and 20 healthy control subjects. Patients with CRF and uremic pruritus on hemodialysis of both sex, any age and not received any systemic treatment for pruritus for at least 3 weeks prior to the study were included in this study. Severity of itching was measured by the 5-D itch score. 5-D is (duration – degree – direction –disability and distribution). Maximum score is 25 and indicate severe itching while the minimum score is 5 and indicate no itching. Skin punch biopsies (3 mm) were taken from them for immunohistochemical studies. Results: The present study found that in the skin of the healthy control participants the expressions of NGF were seen in the epidermal basal layer, but there was no expression in upper and mid epidermal cell layers while in dermis about 75% of them showed mild expression and 25% showed moderate expression. In patients with chronic CRF with pruritus on dialysis the expressions of NGF were strong in epidermal basal layers, upper and mid epidermal layers. There was a strong expression of NGF in dermis with some spindle like infiltrating cells especially in dermal papillae. The present study found that in the skin of the healthy control participants the expression of TrKA were seen in the epidermal basal layer, but there was no expression in upper and mid epidermal cell layers while in dermis 75% of them showed mild expression while 25% showed moderate expression. In patients with chronic CRF with pruritus on dialysis the expressions of TrKA were strong in epidermal basal layers, mid and upper epidermal layers. In dermis especially upper dermis larger number of cells demonstrated strong TrkA immunoreactivity. This study found that there was a significant correlation between the 5-D itch score and age of the patients. There was a significant correlation between the 5-D itch score and degree of expression of both NGF and TrKA. Conclusion: A significant increase in the expressions of NGF and TrKA in CRF patients with pruritus on hemodialysis compared to the healthy control participants and also there was significant correlation between degree of expressions of NGF and TrKA and 5-D itching score could be the cause of initiation and maintenance of pruritus in CRF patients with pruritus on dialysis. | ||||
|
Supplementary Files
|
||||
| References | ||||
|
(1) Atlas of chronic kidney disease in the United States. Incidence, prevalence, patient characteristics, & Modality. United State Renal Data System (USRDS). 2012 Annual data 215-228.
(2) Ahmed AM, Allam MF, Habil ES, Metwally AM, Ibrahiem NA, Radwan M, El-Gaafary MM, Afifi A and Gadallah MA. Development of practice guidelines for hemodialysis in Egypt. Indian J Nephrol. 2010;20(4):193-202
(3) El Minshawy O. End-stage renal disease in the El-Minia Governorate, upper Egypt: An epidemiological study. Saudi J Kidney Dis Transpl 2011;22:1048-54.
(4)Leung KCD. Psychosocial aspects in renal patients. Perit Dial Int. 2003; Suppl 2:S90-4.
(5) Robinson-Bostom L and DiGiovanna JJ. Cutaneous manifestations of end stage renal disease. J Am Acad Dermatol. 2000;43(6):975-86.
(6) Cordova KB, Oberg TJ, Malik M and Robinson-Bostom L. Dermatologic conditions seen in end-stage renal disease. Semin Dial. 2009;22(1):45-55
(7) Pisoni RL, Wikstrom B, Elder SJ, Akizawa T, Asano Y, Keen ML, Saran R, Mendelssohn DC, Young EW and Port FK. Pruritus in haemodialysis patients: International results from the
Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant. 2006; 21(12):3495-3505.
(8) Sultan M, Mansour H, Wahby I and Houdery A. Cutaneous manifestations in Egyptian patients with chronic renal failure on regular hemodialysis. J Egypt Women Dermatol Soc. 2010; 7 :49-55.
(9) Jovanović M. Current concepts of pathophysiology, epidemiology and classification of pruritus. Srp Arh Celok Lek. 2014;142(1-2): 106-112.
(10) Matsuda H, Coughlin MD, Bienenstock J and Denburg JA. Nerve growth factor promotes human hemopoieticcolony growth and differentia-tion. Proc Natl Acad Sci U S A. 1988;85(17):6508-12.
(11) Aloe L, Bracci-Laudiero L, Bonini S and Manni L. The expanding role of NGF: from the neurotrophic activity to immunological diseases. Allergy, 1997;52(9):883-904.
12) Holzer P. Local effector function of capsaicin-sensitive sensory nerve endings: involvement of tachykinins, calcitonin gene-related peptide and other neuropeptides. Neurosci. 1988; 24, 739- 768.
13) Pincelli C and Marconi A. Autocrine nerve growth factor in human keratinocytes. J Dermatol Sci. 2000;22(2): 71-79.
(14) Elman S, Hynan LS, Gabriel V and Mayo MJ. The 5-D itch scale: a new measure of pruritus Br J Dermatol. 2010;162(3):587-93. | ||||
|
Statistics Article View: 202 PDF Download: 215 |
||||
