الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Chronic kidney disease (CKD) is a worldwide health problem, and refers to the presence of structural or functional kidney damage that persists over a minimum period of three months. While end-stage renal disease (ESRD), is the final, permanent stage of CKD, where kidneys can no longer function on their own. Many children with ESRD are at risk for developing musculoskeletal manifestations either due to chronic kidney disease-mineral and bone disorders (CKD-MBD) or dialysis related amyloidosis (DRA).CKD-MBD can be manifested by abnormalities in calcium, phosphorus, and parathyroid hormone (PTH) levels or vitamin D metabolism; problems in bone turnover, mineralization, linear growth, or strength; and vascular or other soft tissue calcifications. While DRA can be presented mainly with carpal tunnel syndrome (CTS), synovitis, joint arthropathy, and destructive spondyloarthropathy due to deposition of beta-2 microglobulin (β2M) in the osteoarticular system. The aim of this study was to evaluate the role of musculoskeletal ultrasound (MSUS) in detection of musculoskeletal manifestations in chidren with ESRD on regular hemodialysis. This study was carried out on a total number of 50 children, divided into 2 groups; 25 children with ESRD on regular hemodialysis; and 25 children classified as CKD in different stages. The study was established in both the Nephrology Unit of Pediatric Department and Physical Medicine, Rheumatology, and Rehabilitation Department of Tanta University Hospitals. Inclusion criteria: Children between 1 to 18 years old with ESRD on regular hemodialysis > 6 months duration. Exclusion criteria: - Patients with ESRD on regular hemodialysis < 6 months duration. - Patients with rheumatological diseases. - Patients with metabolic diseases. - Diabetic patients. All patients were subjected to the following: A) History taking: - Personal history. - Presenting complaint especially musculoskeletal symptoms. - Present history. - Medication history. - Dialysis data for dialytic group. - Family history. B) Complete clinical examination, with special attention to musculoskeletal system: Joints examination: - Inspection:posture, overlying skin, muscle wasting, deformity and swelling. - Palpation: temperature, crepitus, swelling and tenderness. - Movement: Both active and passive movements were examined for each joint, and range of motion. Muscles examination: - Inspection: the size, overlying skin, symmetry, and swelling. - Palpation: strength, bulking, swelling and tenderness. - Movement: Both active and passive movements for tone and flexibility. C) Laboratory investigations: - Complete blood count (CBC). - Blood Urea Nitrogen (BUN) and Creatinine (Creat). - C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR). - Parathormone Hormone (PTH). - Calcium (Ca), Phosphorus (P), Potassium (K) and Sodium (Na). - Arterial Blood Gases (ABG) : PH and HCO3. - Serum level of β2 Microglobulin (β2M). D) Musculoskeletal ultrasound Examination (MSUS): All patients were examined at ultrasonography unit of Physical medicine, Rehabilitation & Rheumatology Department in Tanta University Educational Hospital using SAMSUNG MEDISON (UGEO H60). The joints were investigated with both B-mode US and Doppler US, both in longitudinal and transverse planes using linear multifrequency transducer (dynamic range 9-13 MHZ) for assessment of synovitis (synovial hypertrophy, joint effusion and power Doppler (PD) signal), bone erosions and enthesopathy. In all recommended scans, specific anatomic landmarks had to be present in the image to ensure the same scanning positions in all examinations performed for the study. The results of the present study showed the following: - Musculoskeletal manifestations in CKD includes both chronic kidney disease-metabolic bone disorder (CKD-MBD) and dialysis related amyloidosis (DRA). - Musculoskeletal manifestations are more common in dialytic children than non dialytic ones. - Arthralgia is the most common complain among CKD and dialysis children. - Growth impairment, muscle weakness and bone deformities are obviously more common in dialytic chlidren. - MSUS is more efficient than physical examination in detecting musculoskeletal affection in renal children especially clinical and subclinical synovitis and carpal tunnel syndrome . - Carpal tunnel syndrome, tendinopathy and synovitis are forms of dialysis related amyloidosis. - Musculoskeletal ultrasound findings are clearly related to higher levels of PTH and β2 microglobulin and lower levels of serum ionized calcium and 25-OH vitamin D. - Long duration of dialysis is an important factor affecting severity of muscloskeletal manifestations in dialytic children.