Screening of Gastrointestinal Tract Bleeding Causes Among Chronic Renal Failure Patients

The aim of the current study is to screen different causes and characteristics of Gastrointestinal bleeding in Chronic Renal Failure patients at Assuit University Hospital according to their stages based on e GFR (Stage I to IV), in order to assess different modalities of therapeutic intervention from medical therapy up to therapeutic intervention.

* Chronic Renal Failure is defined as presence of reduced glomerular filtration rate (GFR) \< 60 ml/min/ 1.73 m2 and/or evidence of kidney damage (usually indicated by albuminuria or proteinuria) for \> 3 months or more irrespective of cause (Kiapidou et al., 2019).
* Chronic Renal Failure stages are classified according to the National Kidney Foundation in to five stages according to estimated GFR (Ikizler 2009).
* The prevalence of Chronic Renal Failure is continuously rising in concert with the rising epidemic of its risk factors including ageing, diabetes, obesity, metabolic syndrome, smoking, and hypertension (Stevens and Levin 2013).
* Gastrointestinal bleeding, is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool. Small amounts of bleeding over a long time may cause iron-deficiency anemia resulting in feeling tired or heart-related chest pain.

Other symptoms may include abdominal pain, shortness of breath, pale skin, or passing out. Sometimes in those with small amounts of bleeding no symptoms may be present. (Bong Sik Matthew Kim. 2014)

• Preliminary data suggest an association between Chronic Renal Failure and Gastrointestinal Bleeding. Individuals with even mild to moderate Chronic Renal Failure warrant clinical attention regarding the risk of hospitalization with Gastrointestinal bleeding. (Kunihiro Matsushita, 2016 Oct 7) reported that the prevalence of Gastrointestinal bleeding was significantly higher in patients with Chronic Renal Failure compared to patients without Chronic Renal Failure.

Eligibility Criteria:
Inclusion Criteria:

* One hundred Chronic Renal Failure patients with different stages (stage I to IV) according to the National Kidney Foundation are recruited from inpatients of renal unit in internal medicine department, Assuit university hospitals. Their GFR will assessed by using Chronic Renal Failure EPI equation measured as GFR=166 x(s cr/0.7)-1.209X(0.993)age if female, and GFR=163X(s cr/0.9)-1.209x(0.993)age if male. (Andrews et al 2008).

Chronic Renal Failure staging according to GFR by Chronic Renal Failure EPI is:

* Stage1 in which GFR\>90 mil/min but evidence of kidney damage.
* Stage 2 GFR 60-89 mil/min.
* Stage 3 GFR 30-95 mil/min.
* Stage 4 GFR 15-29 mil/min.
* Stage 5 GFR\<15 mil/min.

Exclusion Criteria:

* All Patients with local causes of Gastrointestinal Bleeding

  * Benign and Malignant tumors in Gastrointestinal Tract.
  * Patients with Hemorrhoids or anal fissures.
  * Patients with Mallory-Weiss tears.
  * patients with Diverticular disease.
  * patients with Colon polyps.
  * patients with infectious causes of GIT bleeding (Salmonella, Shigella)
  * patients with Angiodysplasia.
  * patients with Esophageal varices