الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Childhood obesity is considered a serious health problem worldwide. Epidemiological data show that obesity is related to increased risk of renal injury in children. Obesity also increases mortality risk among children with end-stage renal disease. Moreover, recent studies showed that pediatric renal patients have significantly higher body mass index (BMI) z-scores than the normal population. These data indicate that obesity is an independent risk factor for chronic kidney disease in children.
The aim of the present work was to study the frequency of glomerular hyperfiltration and microalbuminuria, as early markers of renal injury, in obese children and adolescents attending the obesity clinic of Alexandria University Children’s Hospital; and study the relation of these markers to the severity of obesity and the obesity-associated morbidities.
The present study included 74 children and adolescents with simple obesity, aged 5-15.5 years. All enrolled patients were subjected to full medical history and clinical examination, stressing on the blood pressure and anthropometric and obesity measurements. The patients were also subjected to laboratory investigations including: fasting blood glucose (FBG), fasting serum insulin, lipid profile, liver enzymes, serum creatinine and uric acid; in addition to urinary albumin/creatinine ratio (u-ACR). Insulin resistance indices (HOMA-IR and QUICKI) and estimated glomerular filtration rate (eGFR) were calculated, and ultrasound examination of the liver was done to detect the presence of fatty liver. Patients who could be diagnosed with the metabolic syndrome (MetS) were identified.
Statistical analysis of the data obtained showed the following results:
• The mean age of the studied patients was 9.8 ± 2.5 years, with nearly equal gender distribution. Slightly more than half (54.1%) of the patients were pubertal or postpubertal.
• The mean BMI was almost 30 kg/m2, and 17.6% of the patients had severe obesity.
• The great majority (85.1%) of the patients had abdominal obesity, and the mean waist/hip ratio was high (0.97 ±0.10).
• Hypertension (HTN) was observed in nearly one third (32.4%) of the patients, the majority of these (62.5%) were stage 1 HTN, and only 37.5% were stage 2 HTN.
• The majority of the patients (71.6%) had acanthosis nigricans (AN)
• Dyslipidemia was demonstrated in nearly two-thirds (62.2%) of the patients. Around one third of the patients had abnormally high TG and/or low HDL-C (33.8% and 35.1%, respectively).
• Impaired FBG was found in a minority (9.5%) of the patients, but nearly two-thirds of the patients had insulin resistance (66.2% by the HOMA-IR index and 63.5% by QUICKI).
• Nearly two-thirds (63.5%) of the patients had sonographic features of fatty liver, while ALT and AST were elevated in a minority of them (16.2% and 2.7%, respectively).
• The MetS was found in 23% of the studied patients (29.4% of the patients aged ≥ 10 years, and 17.5% of those aged <10 years).
• Half (50%) of the patients had glomerular hyperfiltration, and only 8.1% of them had low eGFR. Only 3 (4.1%) of the patients had high levels of serum creatinine for age.
• Microalbuminuria was found in only 2 patients (2.7%).
• The BMI had significant positive correlation with: age, weight percentiles, waist circumference (WC), HOMA-IR, both SBP and DBP, and significant negative correlation with QUICKI and HDL-C. However, no significant correlation was found between the BMI and the u-ACR.
• There was no significant correlation between the eGFR and obesity measurements or other cardiometabolic risk factors like, BP, lipid profile, FBG, insulin resistance indices, or serum uric acid.
• Obese children with the MetS were found to have significantly higher values of WC, SBP, FBG, HOMA-IR, and TG and significantly lower values of HDL-C and QUICKI when compared to those without the syndrome.
• No significant difference was found between the patients with and those without the MetS regarding serum creatinine and uric acid, u-ACR, eGFR, frequency of glomerular hyperfiltration or frequency of fatty liver.
• Comparing patients with and those without glomerular hyperfiltration, revealed no significant differences between the two groups regarding the demographic data, obesity measurements, pubertal stage, BP, the metabolic indicators, serum UA, u-ACR, the presence of AN, fatty liver or the presence of the MetS.
from the aforementioned results, it could be concluded that:
1. Insulin resistance, dyslipidemia, fatty liver, hypertension, and the metabolic syndrome are very common comorbidities among our obese children and adolescents. Hyperuricemia and elevated fasting blood glucose are less common ones.
2. Glomerular hyperfiltration, an early marker of renal injury, is very prevalent among our obese children and adolescents.
3. No significant relation was found between glomerular hyperfiltration and the severity of obesity or the obesity-associated morbidities.
4. Microalbuminuria, as an early marker of renal injury, is uncommon among our obese children and adolescents.
from this study, the following recommendations could be suggested:
1. Every effort should be exerted to prevent and treat early childhood obesity, in order to minimize the associated cardiovascular, metabolic and renal morbidities.
2. Obese children and adolescents should have periodic GFR estimation. Those with glomerular hyperfiltration have to start promptly a weight-reduction program.
3. Obese children and adolescents have to be monitored for blood pressure, fasting blood glucose, insulin resistance, serum lipids, serum uric acid and fatty liver; for early detection of the common associated morbidities.
4. A similar, but longitudinal and multicenter study, using more precise methods for assessment of the GFR is recommended for better delineation of the renal injury in obese Egyptian children and adolescents.