الفهرس 
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Abstract
Summary
CKD is a growing global health problem, and end-stage
renal disease (ESRD) is a prominent and much feared complication
of the disease.
Chronic kidney disease (CKD) is defined as an abnormality
of kidney function, as determined by clinical, laboratory data and
imaging tests as ultrasonography, which have been present for at
least 3 months. CKD has replaced “chronic renal failure” and
“chronic renal insufficiency” as the globally accepted terminology
for persistent renal dysfunction.
Chronic kidney disease in Egyptian children less than 5
years of age is attributed to parenchymatous disease in 73% of
cases and obstructive etiology in 27% of cases, while after 5years
of age, Parenchymatous disease is the cause in 67% and
obstructive etiology constitutes 33% of cases.
ESRD represent the state in which a patient’s renal
dysfunction has progressed to the point at which homeostasis and
survival can no longer be sustained with native kidney function or
maximal medical management. At this point renal replacement
therapies (dialysis or renal transplantation) become necessary.Hemodialysis should be initiated when one or more of the
following are present: symptoms or signs attributable to kidney
failure (serositis, acid-base or electrolyte abnormalities, pruritus);
inability to control volume status or blood pressure; a progressive
deterioration in nutritional status refractory to dietary intervention;
or cognitive impairment. This often but not invariably occurs in the
GFR range between 5 and10 ml/min/1.73 m2.
However, evaluation of the need for dialysis should begin at
a higher GFR level, probably somewhere around 15-20 mL/
minute/1.73 m². Problems with criteria that are limited to clearance
measures occur in patients with renal impairment who have
problems with fluid overload, hyperkalemia, or “failure to thrive”
that are out of proportion to their GFR. For example, patients with
advanced cardiac disease and borderline GFR may have trouble
with refractory fluid retention.
Many Cardio-vascular complications can occur in ESRD
including anemia, hypertension, vascular calcification and stiffness
of arteries.
Chronic kidney disease (CKD) is associated with premature
atherosclerosis and increased incidence of cardiovascular
morbidity and mortality. Several factors contribute to
atherogenesis and cardiovascular disease in patients with CRF.
Notable among the CRF-induced risk factors are lipid disorders,
oxidative stress, inflammation, physical inactivity, anemia,hypertension, vascular calcification, endothelial dysfunction, and
depressed nitric oxide availability.
When the diagnosis of ESRD is determined, a decision
concerning the most appropriate mode of renal replacement for the
patient must be made. Options for renal replacement therapy
(RRT) for the ESRD include Kidney transplantation, peritoneal
dialysis, hemodialysis and supportive therapy in the form of drugs
for hypertension and anemia and diet control.
Haemodialysis continues to be the most frequently utilized
modality for renal replacement therapy in incident pediatric ESRD
patients.
Oxidative stress may be defined as an imbalance between
the production and elimination of ROS (reactive oxygen species).
Oxidative stress results from either an overproduction of
free radicals or diminution in antioxidant defenses. When this
delicate balance is upset, oxidative stress may lead to cellular
injury and subsequent organ dysfunction.
Although free radicals are potentially damaging, It should
always be remembered that they are also essential for normal cell
function. In this regard, we should try to use the term oxidative
stress when we describe the pathological sequelae to alterations in
the oxidant/ antioxidant status of a cell.The present study was carried out on 35 children with
ESRD on regular hemodialysis in Pediatric Nephrology Unit of
Tanta University Hospital and 35 healthy age and sex matched
children were serving as controls.
All patients and control were subjected to history taking and
clinical examination including anthropometric measurements.
Routine laboratory assessment was done measuring
complete blood picture (CBC),) blood urea, BUN, serum
Creatinin,, PTH, PT, PTT, bleeding time, clotting time ,blood
electrolytes and urine analysis.
In this study, children with ESRD on regular HD were
investigated by serum levels of interleukin 1 β(IL-1β), tumour
necrosis factor alpha(TNF-α), thiobarbituric acid reactive
substances(TBARS) and malondialdehyde (MDA) as indices of
oxidative stress in comparison with the studied healthy children as
a control group.
All patients were receiving antioxidant drugs in the form of
vitamin E in a dose of 5mg/kg/day, vitamin C in a dose of 100-200
mg /day and N-Acetyl Cystiene in a dose of one sachet (200 mg)
twice daily with meal.