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Abstract
Diabetic neuropathy is probably the most common chronic complication of diabetes that encompass a wide range of abnormalities affecting the peripheral nervous system causing considerable morbidity and mortality. The prevelance of diabetic neuropathy approaches 50% in most diabetic populations, and its consequences in the form of foot ulceration and leg amputation may be mandatory as there is no curative therapy for diabetic neuropathies. Uramic Neuropathy develops during the course of chronic kidney disease and it is present in up to 65% of patients at the initiation of dialysis, and the severity of neuropathy is correlated strongly with the severity of the renal insufficiency. Nerve growth factor (NGF) is a neurotrophic polypeptide, belongs to a closely related family of neurotrophins composed of brain-derived neurotrophic factor, neurotrophin-3, and neurotrophin-4/5. it selectively promotes the differentiation and maintenance of small fibre sensory and sympathetic neurons in the peripheral nervous system. Later studies have suggested that decreased availability of NGF contributes to the pathogenesis of diabetic polyneuropathy. The present study was aimed to find out how much the changes in the level of nerve growth factor and nerve conduction velocity in some types of neuropathy (diabetic and uraemic) and to find out any relation between serum level of nerve growth factor and each of degree of glycemic control , duration and type of diabetes in diabetic subjects, to the degree of renal affection and sufficient dialysis in uraemic patients and to the degree of neuropathy and nerve conduction velocity in different types of neuropathy. This study had been carried out on 90 subjects, they were divided into 3 groups.Group I- included 10 healthy subjects as a control group. Group IIa- it included 40 patients with diabetic peripheral neuropathy 20 0f them with type I diabetes mellitus and the other 20 with type II diabetes mellitus). Group II b- it included 40 patients with uraemic peripheral neuropathy, 20 of them under conservative treatment and the other 20 on regular dialysis (pertonial or haemodialysis)} . All subjects of this study subjected to the following investigations: liver function tests, kidney function tests ,complete blood picture, fasting and 2 hours postprandial blood glucose level , glycosylated haemoglobin (HBA1c), urine and stool analysis, E.S.R., lipid profils, serum nerve growth level and nerve conduction velocity measurment. The following results were obtained: ? There was a significant decrease in the serum nerve growth factor levels and nerve conduction velocity in the whole groups compared to the control .? There was a significant decrease in the serum nerve growth factor levels and nerve conduction velocity in type 1diabetic patients as compared to type II.? A highly significant negative correlation was found between both of nerve growth factor (NGF) and nerve conuction velocity (NCV) to each of fasting blood glucose, glcosylated haemoglbulin, duration of diabetes, symptoms and examination scores in diabetic patients with peripheral neuropathy.? There was a significant positive correlation between neuropathy scores and each of fasting blood glucose,glcosylated haemoglbulin,and duration of diabetes ,while there was a highly significant negative correlation with nerve conduction velocity of four measured nerves in diabetic patients with P.N.. ? A significant decrease in the serum nerve growth factor and nerve conduction velocity was found in chronic renal failure patients on conservative treatment as compared to these on regular dialysis.? A highly significant negative correlation was found between both of nerve growth factor and nerve conuction velocity to each of serum urea, and serum creatinine and symptoms and examination scores . while there was non significant correlation between them and duration of dialysis in uraemic patients with peripheral neuropathy .? There was significant positive correlation between neuropathy scores and each of serum urea, and serum creatinine , while there was a highly significant negative correlation with duration of dialysis and nerve conduction velocity of four measured nerves ,in uraemic patients with peripheral neuropathy.