الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Childhood immune thrombocytopenic purpura (ITP) is a benign self-limiting condition without serious bleeding problems. The most appropriate initial therapy for children with ITP remains controversial. Once the decision to treat a patient with ITP has been made, corticosteroids are the standard initial treatment. Corticosteroids can exhibit a wide range of adverse effects. For our knowledge,little data were published regarding corticosteroid nephrotoxic side effects so we aimed in this study to asses if there is renal dysfunction in children with ITP due to corticosteroid therapy. This study was conducted on 33 children with immune thrombocytopenic purpura; during the period from March 2013 to April 2014. All children are newly diagnosed ITP patients. The patients were classified into two main groups ; group I : patients who needed corticosteroid therapy (18 ITP patients) and the group II : patients who did not need corticosteroid therapy(15 ITP patients). All individuals were subjected full history taking and thorough clinical examination with special emphasizes on purpuric sites, number and distribution and mucous membranes bleeding, petichae and organomegaly. Laboratory assessment was done to the study groups including investigation to detect renal impairement including blood urea concentration, serum creatinine concentration, eGFR, serum cystatin C and urinary albumin. Our result showed that at diagnosis the 2 patient groups of ITP showed no significant difference regarding blood urea, serum creatinine, eGFR serum cystatin C or urinary albumin. in comparison with each others or with control group. Compared to group II ( ITP did not require therapy) and to control group , ITP children in group I after steroid therapy had significant increase in serum creatinine and serum cystatin c, significant decrease in eGFR and non significant change in blood urea or urinary albumin. The same was true in paired analysis comparing ITP patients post steroid with their investigation pre-steroids. Studying correlation between eGFR and renal function parameters in children with ITP at diagnosis , in group I pre and post steroid therapy the results revealed that there was no significant correlation between eGFR and different tested parameters except with serum creatinine where there was significant negative correlation. On evaluating blood urea , urinary albumin, serum creatinine and serum cystatin C as predictors of e GFR in ITP patients at diagnosis we found that only serum creatinine is considered as an independent predictor of GFR in ITP patients. Again the same was for group I after steroid therapy. from this study, we conclude that corticosteroid administration in ITP patients increased serum creatinine concentrations, decreased e GFR and increased serum cystatin C concentrations that was uncorrelated to eGFR. Although the mechanism/s of these changes remains to be clarified, from the clinical point of view, administration of corticosteroid in children with ITP should be taken into account with regular serum creatinine estimation.