الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Chronic renal failure (CRF) is a reduction in the glomerular filtration rate (GFR). It has many causes including: glomerular diseases, pyelonephritis, hereditary nephropathies, urologic abnormalities, multisystem disease as hemolytic- uremic syndrome and systemic lupus erythematosus. It is a chronic low grade inflammatory condition affecting multisystem with wide range complications as protein energy wasting (PEW) and cardiovascular diseases
Chronic kidney disease (CKD) is a major public health problem. Adverse outcomes of chronic kidney disease can be prevented through early detection and treatment. Earlier stages of chronic kidney disease can be detected through routine laboratory measurements.
CKD has been defined as kidney damage (manifested by renal biopsy, blood, imaging or urine tests abnormalities) lasting for ≥3 months with or without a decreased GFR or any patient who has a GFR < 60 ml/min /1.73 m² lasts for 3 months with or without kidney damage.
End-stage renal disease ESRD is a term defining patients with stage 5 CKD with GFR < 15 ml/min /1.73 m². Options for renal replacement therapy for ESRD include: Kidney transplantation, peritoneal dialysis, hemodialysis and supportive therapy in the form of drugs for hypertension, anemia and diet control.
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Hemodialysis (HD) continues to be the most frequently utilized modality for renal replacement therapy in ESRD pediatric patients.
Cardiovascular morbidity and mortality are common in end stage renal disease (ESRD) patients. Due to the increased survival of children on renal replacement therapy, long- term cardiovascular complications of uremia are of great concern. Among these cardiovascular complications; valvular and myocardial calcification and atherosclerosis have a great significance
Multiple reasons for increasing the incidence of cardiovascular mortality and morbidity in ESRD patients have been considered; such as dyslipidemia, hypertension, low grade inflammation hyperhomocysteinemia and disturbance of calcium and phosphorus homeostasis. Uremia accelerates atherosclerosis by inducing abnormal lipid metabolism and low-grade inflammation.
Uremia associated inflammation due to renal or systemic inflammatory disease, heart failure and dialysis dependent procedures may exacerbate atherosclerosis in chronic kidney disease (CKD) patients.
Vascular ultrasound has a number of potential advantages for the clinical diagnosis of vascular diseases. The most obvious is its non-invasiveness and the negligible degree of patient discomfort and morbidity it causes. Ultrasound has some less obvious, but important advantages over more standard imaging technologies such as
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angiography. Vascular ultrasound provides multiple longitudinal viewing angles for analysis of arterial lesions, as well as transverse views. It also visualizes the arterial wall and its components, whereas angiography visualizes the arterial lumen. High resolution carotid ultrasound is a recognized method of evaluating changes in blood vessel walls both in adults and children.
Carotid intima- media thickness (CIMT) is the noninvasive technique most frequently used in clinical trials to determine atherosclerosis. Clinical guidelines and medical societies recommend it to obtain a more precise evaluation of cardiovascular health in selected populations, and in cardiovascular disease prevention programs.
This study was done in the pediatric hemodialysis unit in the pediatrics department at Menoufia university Hospital. The study was carried out on 60 children divided into 3 groups: Group I (Pre-dialysis group): Patients with chronic renal insufficiency (CKD stages 2, 3 & 4) of different causes on conservative treatment and not required dialysis before also were included in this study. Group II (Dialysis group): Patients with end stage renal disease (ESRD) of different causes on regular hemodialysis therapy. Group III (control group): 20 healthy children with matched age and sex were served as control group.
All patients and control were subjected to detailed history taking, clinical examination and investigations as follows: CBC, blood urea, serum creatinine, serum Ca, Po4, parathyroid hormone and uric acid, C-reactive protein (CRP), total cholesterol, triglycerides, LDL, HDL,
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total bilirubin and albumin.The glomerular filtration rate was calculated by the Schwartz formula.
The carotid artery intima media thickness (cIMT) was also measured as an indicator of atherosclerosis
There was a highly significant increase in Carotid intima-media thickness (CIMT) of patients on conservative treatment and dialysis compared to the controls.
Carotid intima-media thickness correlated negatively with body mass index, haemoglobin level, haematocrit, estimated glomerular filtration rate, serum calcium and albumin and HDL levels and positively with systolic& diastolic blood pressure, CRP, serum urea, creatinine, parathyroid hormone, total bilirubin level and total cholesterol levels.
In conclusion, CKD is associated with significant arterial wall abnormalities in children. This suggests that even in young children, uraemia and/or metabolic alterations have a profound impact on arterial structure and function leading to cardiovascular morbidity and mortality. Functional change in the cardiovascular system may start when kidney function is mildly impaired.
This study recommends regular measurement of carotid intima-media thickness in children with chronic renal failure and proper management of hypertion, anemia, malnutrition, bone disease and dyslipidemia in children with chronic renal failure.