الفهرس 
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Abstract
Chronic renal failure may affect virtually every system in the body, including the lungs. Pulmonary dysfunction may be the direct result of circulating uremic toxins or may result indirectly from volume overload, anemia, immune suppression, extra osseous calcification, malnutrition, electrolyte disorders and/or acid base imbalance. The pulmonary system is unique because it is affected by the disease and its treatment.
Pulmonary edema and pleural effusion attributed to fluid overload and an increase in pulmonary capillary permeability are relatively common. Rarer complications include pulmonary fibrosis and calcification, pulmonary hypertension, haemosidrosis, pleuritis and pleural fibrosis. Renal replacement therapy may also result in complications. Hemodialysis causes recurrent episodes of hypoxemia due to partial blockage of the pulmonary capillary bed by white cells, or silicone microemboli.
Renal transplantation introduces the further hazards of lung infection and lung complications from immunosuppressive drugs. In patients with CRF, repeated pulmonary insults through various mechanisms could damage the alveolocapillary wall and induce a reduction of the diffusion capacity without obvious pulmonary symptoms and findings.
Pulmonary function tests measure the ability of the respiratory system to accomplish its main task, which is gas exchange by assessing ventilation, diffusion, gas exchange and static and dynamic mechanical properties of the respiratory system.
Summary
The aim of this study was to evaluate the PFTs in a group of patients with CRF on regular HD therapy using spirometry and to study the possible risk factors for pulmonary dysfunction in these patients.
The present study was carried out on patients with CRF undergoing regular HD therapy. They were 25 patients but 3 of them were excluded. The remaining 22 patients were 9 girls and 13 boys with an age range of 10 to 18 years (mean 14.4±2.57 years). All were on regular HD therapy with three HD sessions weekly and a HD therapy duration range of 7 to 120 months (mean 42 ± 32.9 months).
Apparently healthy 20 children of comparable age and gender were included as a control group.
All the groups were subjected to the following:
Complete clinical evaluations (history and physical examination).
Laboratory investigations as CBC, serum creatinine and BUN levels both before and after HD, serum calcium, serum phosphorus, serum ferritin level.
Spirometric evaluation of the pulmonary function both before and after HD sessions.
Our results showed that:
Pulmonary function tests in patients with CKD are impaired and their values are significantly lower than those in healthy children.
Pulmonary symptoms weren’t profound, however the PFTs showed impairment in all members of the patient group.
Among the various patterns of PFTs, the restrictive type predominated.
Summary
Poor nutritional status, anemia, hypocalcemia and hyperphosphatemia were dominant findings in patients with CKD and were significantly related to impaired PFTs in these patients.
Hyperferritinemia was a dominant finding in patients with CKD, the main contributor to is mostly MICS rather than iron overload.
Pulmonary function tests in patients with CKD significantly improved after HD sessions.
The improvement of PFTs in patients with CKD wasn’t related to the degree of weight reduction following HD sessions.