**2.8 Apparatus**

50 Chronic Kidney Disease

Taking of a detailed history and physical examination at the initial contact with the patients with view to determining whether the patients had features suggestive of CRF and also whether patients met the inclusion criteria. Those with obvious exclusion criteria were

Twenty-four hours urine was collected and used for estimation of creatinine clearance and 24hours urinary calcium. On the morning of the test (8.00am), patients emptied their bladder and discarded the urine. Subsequently, urine passed was put into a clean container until 8.00am the next day. At the end of the urine collection, 5mls of blood was collected from the patients for estimation of serum creatinine. The creatinine clearance was calculated by using the formula: UV/P, where V is the urine flow rate (mls/min). Normal values of creatinine clearance was taken as 105-150mls/min while 24 hours urinary calcium was taken as 100-300 mg/dl. Where it was necessary radiograph of the chest and lumbo-sacral spines were carried out to rule out metastatic bone lesion. An abdominal ultrasonographic scan was carried out. After these evaluations a total of 52 subjects were studied having met the

The eventual 52 subjects who satisfied the inclusion criteria were required to complete a researcher administered questionnaire which includes age, sex, occupation, dietary habits, clinical symptoms of ROD, frequency and regularity of dialysis. Physical examination was

Ten milliters (10ml) of venous blood was drawn from the remaining 60 patients from a suitable vein with loose fitting tourniquet. The blood sample was used to assay for serum alkaline phosphatase levels, bone specific alkaline phosphatase levels, serum albumin levels,

Osteocalcin, hydroxyproline, parathyroid hormone and calcitriol assays were not carried out because of lack of necessary facilities. However, a surrogate for parathyroid hormone was

Glomerular filtration rate was determined by 24hour urinary creatinine clearance. Also 24hour urine calcium was determined from the 24 hr urine. Plain x-rays of the wrist/ phalanges of both hands and / or lumbo-sacral spine to include the pelvis was carried out looking out for features of osteodystrophy. Bone histology, though more sensitive in the diagnosis of ROD than radiographic evidence could not be done in live subjects because consent for the procedure was refused. 20 of the CRF patients died during the study. However, out of these, only 14 died in the hospital and the corpse deposited in the mortuary. Post mortem bone biopsies were done on 10 of the 14 bodies whose relations gave

40 patients without the exclusion criteria and who did not have the have renal failure but attending out -patient clinic of UBTH, whose ages ranged from 18-65years were used as

consent for the post mortem after obtaining consent from relations.

dropped from the study at this level. This resulted in the exclusion of 55 subjects.

A total of 115 patients were screened by:

inclusion criteria.

**2.7 Study design** 

controls.

performed by the investigator.

calcium and phosphate levels.

taken as total serum alkaline phosphatase.
