الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
CKD is an uncommon problem in pediatrics. Early recognition is important because significant advances have been made in therapy. The prognosis has significantly improved with management. Unfortunately because of the lack of registries, there are no figures on the incidence and characteristics of children with CRF in Egypt. So we construct this prospective observational cohort study to evaluate the baseline characteristics among children with CRF and to evaluate the efficacy of management of children with CRF to achieve the optimal car for those children. The characteristics of our patients were revised and followed up for one year. Mean age at onset of CKD was 6.95 4.6 years. Fifty eight (58.6%) were males and forty one (41.4%) were females. A considerable proportion of childhood CKD was due to partially correctable urinary tract abnormalities including; obstructive uropathy, PUV, VUR and complex genito-urinary tract anomalies. Glomerulonephritis was the second common etiology (16.2%) represented by cresentic GN, chronic GN and membranous GN. Other causes include renal hypo-/dysplasia, HUS, ATN, pyelonephritis, oxalosis and polycystic kidney. We can not identify etiology in twelve (12.1%) cases. Most of our cases were presented by growth retardation (37.4%). Hypertension is the second most common presenting manifestation (20.2%). Other presenting manifestations include pallor, vomiting, encephalopathy and CHF. Most of our patients presented in stage 4 CKD (51.5%). ESRD was detected in 25.7% of our patients. Follow up of kidney function in the predialysis group in the current study revealed that there is no significant change in serum creatinine values allover the study period however there was a significant improvement in the GFR values. This improvement in kidney function may be attributed to partial correction of urological abnormalities. Baseline evaluation of the predialysis group revealed that; 38.6% of them had height SDS below -1 and 19.3% of them had MAC SDS below -1, 77 % of them were anemic moreover serum ferritin and TSAT values were below the target and 19.1% of them were hypertensive. By the end of the study evaluation of the predialysis group revealed that, there were a significant improvement in height SDS, MAC SDS, serum albumin values, mean serum ferritin values and TSAT values whereas there were a significant decrease in serum phosphorus and TIBC values. There were no significant change in serum calcium and calcium phosphorus product. On the other hand baseline evaluation of the dialysis group revealed that there were 20 (76.9%) of them had height SDS below -1, 21(84%) of them had MAC SDS below -1, 92 % of them were anemic, 69.2% were hypertensive and 14(53%) of them had kt/v <1.2. By the end of the study evaluation of the dialysis group revealed that there were a significant improvement in mean MAC SDS, nPCR, serum calcium, serum iron, hypertension control and kt/v values. Whereas there were no significant change in mean height SDS, serum albumin, serum phosphorus, calcium phosphorus product, serum ferritin, TIBC, TSAT and Hb values. In spite of the improvement in the nutritional status of the dialysis group patients they can not catch growth as the growth velocity in this phase is GH dependent. The marked improvement of the dialysis adequacy in our cases may be due to the dialysis related modifications that we have made regarding appropriate biocompatible filter selection, suitable session period and high pump rates. Also because of the improvement in nutritional status, iron status and hypertension control. The Ln kt/v is recognized as a valid and simple alternative to UKM kt/v in adults receiving hemodialysis. On comparing UKM kt/v with Ln kt/v formula for our cases in the dialysis group we found that there was a positive significant orrelation between UKM kt/v and Ln kt/v formula. These results support the use of the Ln formula as a valid alternative to formal UKM in children. The simplicity of this formula should allow for the use of kt/v as the best measure to study the relationship between delivered dialysis dose and outcomes in children. On reviewing the literature we found only one study that performed the same work in pediatric population. The value of using Ln kt/v is two-fold. First, with this formula, kt/v can be derived in under 1 minute by programming any scientific calculator, standard spreadsheet, or database program, allowing for easy derivation of kt/v by those pediatric units that do not have access to formal UKM programs. Second, a simply derived kt/v is more valuable than a simply calculated urea reduction ratio, which is currently used in many pediatric hemodialysis units. Calculation of urea reduction ratio alone does not account for intradialytic urea generation or the urea removed by ultrafiltration and therefore does not yield the vital information necessary to make the best possible evaluation. The drawback of using a simplified method for Ln kt/v is that such methods do not provide information regarding nPCR. Assessment of nutrition, especially in children, is equally important as measurement of urea removal. One can combine the kt/v derived by the Ln formula, nPCR derived by an algebraic equation using the urea generation rate and clinical assessment to critically evaluate the volume and nutritional status of a pediatric patient. There were positive significant correlations between UKM kt/v and nPCR and serum ferritin whereas there was a negative significant correlation between UKM kt/v and Ca P product