**2.12.1 Principle**

After the determination of the total serum alkaline phosphatase as described above, the serum is heated for 13 minutes at 560c to inactivate the bone- type isoenzyme. The sera are now read as in the determination of the total serum alkaline phosphatase using a spectrophotometer set at 520 millimicron wavelength.

The concentration of serum alkaline phosphatase excluding the bone isoenzyme was determined as was done for total alkaline phosphatase using a spectrophotometer set at 520millimicron wavelength. The bone isoenzyme was determined by subtracting this value from the total alkaline phosphatase. Values of bone specific alkaline phosphatase level greater than 50% of total serum alkaline phosphatase shows significant contribution from bone iso-enzyme.

#### **2.13 Bone histology (post mortem)**

#### **2.13.1 Procedure**


The Prevalence of Renal Osteodystrophy in

Sex

Age (Yrs)

BAP (iu/l)

in figure1.

Renal sizes (cm) Right Left

Creatinine clearance (mls/min) Total alkaline phosphatase (iu/l)

24 hours urine calcium (mg/dl)

Table 2. Characteristics of CRF and control group.

**3.2 Symptoms of renal osteodydtrophy (ROD)** 

common in both sexes (1 male and 1 female).

Serum calcium (mg/dl) Serum phosphate (mg/dl)

Serum creatinine (mg/dl)

Blood urea (mg/dl)

Serum protein (gm/dl)

Characteristics CRF Group (n=52)

Chronic Renal Failure Patients in Urban Niger Delta of Nigeria 55

Control Group (n=40) Mean +SD

M (22), F (18) 40.38 + 11.3

11.99 + 0.32 11.92 + 0.33 126 + 7.3 43.73 + 8.31 21.8 + 4.11 9.12 + 0.5 3.20 + 0.6 3.8 + 1.76 0.8 + 0.15 24.4 + 5.6 4.46 + 0.52

P Value

>0.05

<0.05 <0.05 <0.05 <0.05 <0.05 <0.05 <0.05 >0.05 <0.05 <0.05 >0.05

Mean + SD

M (30), F (22) 42.5 + 11.6

8.33 + 0.5 8.16 + 0.5 9.8 + 6.7

129.4 + 21.6 83.12 + 21.6 6.9 + 2.3 6.1 + 1.9 1.7 + 2.37 7.16 + 2.4 123.8 + 39.8 3.2 + 0.60

In the age ranges <30 years and 31 – 40 years, the mean creatinine clearance were 7 + 1.83 mls/min and 12.6 + 2.16 mls/min respectively. In the age ranges 41 – 50 years and 51 – 60 years, the mean creatinine clearances were 8.6 + 3.2mls/min and 8.2 + 2.6mls/min respectively. In the age range >60 years, the mean creatinine clearance was 11.8 + 5.2mls/min. Creatinine clearance was lowest in the <30 years age range. This is represented

The symptoms suggestive of ROD in the study population include bone pain and pruritus. 7(14%) of the CRF group had symptoms. This was made up of 5(71%) that had bone pain and 2(29%) that had pruritus. 5(12%) of the control group had bone pain. None had pruritus. The symptom of bone pain was commoner in males compared to females. Of those that had bone pain, 4 (80%) were males while 1 (20%) was a females. Pruritus was equally as

The entire patients that had pruritus in the CRF group had elevated serum alkaline phosphatase, hyperphosphataemia and elevated calcium-phosphate product. There was a statistically significant correlation between bone pain and creatinine clearance (r =-0.3), such that bone pain occurred more commonly in patients with end stage renal disease (ESRD).

