الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Nonalcoholic fatty liver disease (NAFLD), a common pathological condition worldwide, is becoming one of the most serious complications of obesity in children and adolescents. NAFLD emerged as a leading cause of chronic liver disease. It is characterized by substantial variability in severity and rate of liver disease progression.(180) NAFLD is associated with an increased risk of developing extra hepatic chronic diseases including chronic kidney disease(CKD).The underlying mechanisms remain unclear.(180) Recognition of the influence of NAFLD on renal function allows early treatment of CKD. Routinely used measures of renal function, such as levels of blood urea nitrogen (BUN) and serum creatinine, increase significantly only after substantial kidney injury occurs and then with a time delay. Cystatin C, a low molecular weight protein, has been proposed a sensitive endogenous marker of renal function and assessment of glomerular filtration rate(GFR). This study aimed to evaluate serum cystatin C as an early marker of renal dysfunction in children and adolescent with NAFLD. The study was conducted on 60 overweight/obese children and adolescents. Their ages ranged from 3.5 to 16.5 years with a mean of (9.10±3.14 years) . They were divided into two groups: 30 cases with NAFLD diagnosed by abdominal ultrasound and 30 cases without NAFLD. Twenty healthy age- and sex- matched children served as controls. RESULTS: There was a significant increase in weight Z score and BMI Z score in NAFLD patients compared to controls. There was a significant increase in W/H ratio in NAFLD patients compared to controls. There was increased levels of liver enzymes (ALT, AST) in NAFLD patients compared to those without NAFLD and controls. There was increased levels of total cholesterol and LDL in NAFLD patients compared to controls. There was a significant decrease in HDL level in NAFLD patients compared to controls. However, there is no significant difference between NAFLD patients and those without NAFLD regarding lipid profile. Fasting plasma insulin and insulin resistance(IR) values were significantly higher in NAFLD and non-NAFLD patients compared to controls and also in NAFLD compared to non-NAFLD patients. There was no significant difference in urine albumin levels in NAFLD patients compared to those without NAFLD and controls. There was a significant increase in serum Cystatin C levels in NAFLD patients compared to those without NAFLD and controls. Ultrasonic grading of hepatic steatosis showed that 19(63%),8(27%) and 3(10%) cases were found in grade I, grade II and grade III, respectively. Serum Cystatin C correlated significantly to the degree of hepatic steatosis. There was a significant reduction of eGFR in NAFLD patients compared to those without NAFLD and controls. The reduction in eGFR was correlated with the degree of hepatic steatosis. Serum cystatin C levels were inversely correlated with eGFR. Levels of eGFR were correlated significantly with weight, BMI, W/H ratio, ALT, AST, cholesterol and insulin resistance(IR).