Assessment of cognitive functions and adaptive behavior in children with end-stage renal disease on regular hemodialysis.

Chronic kidney disease (CKD) is defined by the Kidney Disease and Outcome Quality Initiative as a child who has kidney damage lasting for at least three months with or without decreased glomerular filtration rate. Hemodialysis (HD) means removal of waste products and extra fluid directly from the blood when the kidneys do not work properly. Studies aimed at investigating neurocognitive impairment in children with CKD have identified a wide range of delays in cognitive development. The aim of this study was to assess the cognitive functions and adaptive behavior in children with end-stage renal disease (ESRD) on regular HD. This case-controlled study was conducted on 30 children suffering from ESRD who were on treatment at the Pediatric Nephrology Unit of Tanta University Hospital. Thirty apparently healthy children served as a control group, in the period from January 2017 to January 2018. All children were subjected to full history taking, careful physical and neurological examination, specific investigations including assessment of intelligence quotient (IQ) using Stanford Binet test 5th edition; assessment of adaptive behavior, assessment of executive functions by using Wisconsin Card Sorting Test; and continuous performance test. This study showed that mean values of IQ and the Vineland test were significantly lower among patients than controls. The study suggests that children with ESRD had lower IQ, adaptive behavior and executive functions than healthy control children.

Incidence, risk factors and causative bacteria of urinary tract infections and their antimicrobial sensitivity patterns in toddlers and children: A report from two tertiary care hospitals.

Urinary tract infection (UTI) is one of the most common bacterial infections among children. It is noted that the risk of renal damage from UTI is the greatest in children younger than five years, thus early diagnosis and prompt treatment are important. The aim of this study was to assess the incidence of UTI in children attending pediatric outpatient clinics in Zagazig and Tanta University Hospitals as tertiary care hospitals. Furthermore, we attempted to determine related risk factors, isolate the organisms that cause UTI in children, and study their antibiotic susceptibility patterns. This cross-sectional descriptive study was conducted on 1200 toddlers and children, (754 boys and 446 girls) aged between 30 months and seven years attending the pediatric outpatient clinics of Zagazig and Tanta University Hospitals. All patient groups were subjected to full medical history, physical examination, dipstick analysis by using both nitrite and leukocyte esterase (LE) detectors, microscopic examinations, and urine culture for cases with the positive LE, positive nitrite dipstick test for urine or positive for both LE and nitrite. The incidence of UTI among children included in the current study was 7%. Positive LE was seen in 112 (9.3%), nitrite positivity was seen in 94 (7.8%), and both LE and nitrite positivity in 34 (2.8%). Escherichia coli was the most common organism. Cefotaxime and amikacin were the most common sensitive antibiotics to the isolates.

Plasma cystatin C versus renal resistive index as early predictors of acute kidney injury in critically ill neonates.

INTRODUCTION: Acute kidney injury (AKI) independently predicts morbidity and mortality of critically ill neonates. Serum cystatin C is a promising early biomarker for AKI. Evaluating the renal resistive index (RRI) by Doppler ultrasound demonstrates abnormal intrarenal vascular impendence. OBJECTIVE: The objective of this study was to compare the ability of plasma cystatin C and the RRI to predict AKI early in critically ill neonates. STUDY DESIGN: Sixty critically ill neonates in neonatal intensive care units were assigned to three groups: group 1 (cases) of thirty participants fulfilling the AKI diagnostic criteria of neonatal Kidney Disease Improving Global Outcome, group 2 of thirty participants not fulfilling the criteria, as well as the 3rd group of thirty age- and sex-matching healthy participants. RESULTS: Group 1 demonstrated a significantly high mean cystatin C level during the 1st day of incubation compared with the other two groups [group 1 (3.18 ± 1.25), group 2 (1.68 ± 0.66), and group 3 (0.80 ± 0.26)]. Serum creatinine and RRI were insignificantly different among all groups. At a cutoff value of 2.68 (mg/l), cystatin C level had significantly higher area under the curve (AUC) (0.804) than both serum creatinine (0.453) and RRI (0.551) and had 53.3% sensitivity and 100% specificity in the early prediction of neonates with AKI. The RRI had a lower non-significant AUC (0.551) at a cutoff value of 0.53 and had 100% sensitivity and 40% specificity, while serum creatinine had a low non-significant AUC (0.453) at a cutoff value of 0.49 (mg/dl) and had 33.3% sensitivity and 86.7% specificity. Applying regression analysis to predict AKI in critically ill neonates as early as possible, higher plasma cystatin C and lower estimated glomerular filtration rate cystatin were the only independent risk factors within critically ill neonates. CONCLUSIONS: The level of plasma cystatin C increased 48 h before both RRI and serum creatinine did in critically ill neonates who developed AKI, so it is more reliable in predicting AKI in critically ill neonates than serum creatinine and RRI.

Diagnostic and Prognostic Values of Antinuclear Immunoglobulin G in Pediatric Lupus Patients.

INTRODUCTION: Systemic lupus erythematous (SLE) as an autoimmunedisease caused by self immunoglobulin. It was proposed thatthe chromatin including nucleosomes is the main antigen inthe pathogenesis of SLE, and that antinuclear immunoglobulinG are associated with disease activity. Aim of the study was tostudy the diagnostic and prognostic value of serum levels ofantinuclear immunoglobulin G as the most famous anti-chromatinimmunoglobulin as a diagnostic tool and a disease activity markerin juvenile systemic lupus erythematous. METHODS: The work was conducted on 90 pediatric Lupuspatients who attended to the Pediatric Nephrology Unit ofPediatric Department of Tanta University Hospital. Also on thirtyapparently healthy children with matched age and sex served asa control group. All subjects were subjected to history in details,clinical examination, SLEDAI score, anti-dsDNA and antinuclearimmunoglobulin G assay . RESULTS: The mean serum level of antinuclear immunoglobulinG was statistically significantly higher in patients than controls(P < .001). But there was no statistically significant differencebetween patients' subgroups. There was a weak positive correlationbetween serum antinuclear immunoglobulin G and SLEDAI score(r = 0.213) but strong correlation between anti-dsDNA antibody andSLEDAI score (r = 0.711). Antinuclear immunoglobulin G showedhigher sensitivity but equal specificity to anti-dsDNA antibody forthe diagnosis of pediatric lupus patients. CONCLUSION: Antinuclear immunoglobulin G are more accurate thananti-dsDNA antibodies in the diagnosis of pediatric lupus patientsin anti-dsDNA negative children as antinuclear immunoglobulin Ghave higher sensitivity but as regard to disease activity antidsDNAantibody is more accurate.

Predictive values of dyslipidemia and B-type natriuretic peptide levels in juvenile systemic lupus erythematosus: A two center-experience.

B-type natriuretic peptide (BNP) is a biomarker that helps in determining the diagnosis and prognosis of heart failure (HF). There is an increased risk for cardiovascular disease (CVD) in systemic lupus erythematosus (SLE) with high disease activity, demonstrated by the higher frequency of dyslipidemia and higher BNP concentrations than in healthy controls. The aim of the work was to evaluate the association between the levels of lipids and BNP in pediatric patients with SLE with HF. We classified our subjects into three groups as follows: Group 1 (active SLE group): included 38 patients who subgrouped into 16 with HF and 22 without HF; Group 2 (inactive SLE group): included 38 patients, and Group 3 (control group): included 38 apparently healthy children. All children were subjected to complete history taking, clinical examination, SLE disease activity index scoring and investigations included complete blood count, erythrocyte sedimentation rate, 24-h urinary protein, anti-double strand deoxy-ribonucleic acid and anti-nuclear antibody, lipid profile, serum albumin, protein, and BNP. There was a significantly elevated lipid level and decreased high-density lipoproteins in lupus patients than in healthy controls. The dyslipidemia was more prevalent in active SLE. There were significantly elevated BNP levels in lupus patients than in healthy controls. In this study, we found that BNP was a biomarker in determining the diagnosis and prognosis of HF. This study revealed that BNP levels were increased in SLE patients without cardiac symptoms as compared to healthy controls; furthermore, the BNP levels were higher in active SLE patients with HF. The data indicated that there is a high risk for CVD in SLE with high disease activity, as demonstrated by the higher frequency of dyslipidemia and higher BNP concentrations than in healthy controls.

Early Predictors of Renal Dysfunction in Pediatric Patients with Sickle Cell Disease.

Sickle cell disease (SCD) is a hereditary hemoglobinopathy characterized by abnormal hemoglobin production which leads to hemolytic anemia and intermittent occlusion of small blood vessels, which further leads to tissue ischemia, chronic organ damage, and organ dysfunction including urinary system. To measure the serum levels of cystatin-C and beta 2 microglobulin in pediatric patients with SCDand to investigate their significance as early biomarkers of glomerular and/or renal tubular dysfunction. This study was conducted among 70 children with SCD and 40 age and sex-matched children as a control group. All subjects underwent a full medical history, through physical examination, laboratory investigations including blood urea, serum creatinine, serum ferritin, estimated glomerular filtration rate (eGFR) using the Schwartz formula, creatinine clearance, urinary albumin/creatinine ratio, serum cystatin-C, and ß-2 microglobulin levels. Pediatric patients with SCD had significantly higher serum cystatin-C and ß-2 microglobulin levels compared to controls. In addition, serum cystatin-C and ß-2 microglobulin levels were positively correlated with blood urea, serum creatinine, serum ferritin, urinary albumin/creatinine ratio, duration of iron chelating agents and frequency of blood transfusion/year. Serum cystatin-C and ß-2 microglobulin levels were negatively correlated with hemoglobin. Our data concluded that serum cystatin-C and ß-2 microglobulin had highersensitivity and specificity (91%, 90% and 85.7%, 100%, respectively) than serum creatinine (79% and85%, respectively). Serum Cystatin-C and ß-2 microglobulin are early specific and sensitive biomarkers for evaluating glomerular and tubular dysfunction in children with SCD.

Risk factors and prevalence of cardiac diseases in Egyptian pediatric patients with end-stage renal disease on regular hemodialysis.

Cardiac disease is a significant cause of morbidity and mortality in children with end-stage renal disease (ESRD). The aim of this work was to study the risk factors and prevalence of cardiac diseases in Egyptian pediatric patients with ESRD under regular hemodialysis (HD). Sixty-six children with ESRD on regular HD were included and subjected to history, clinical, laboratory, chest X-rays (CXR), ECG, and two-dimensional echocardiographic study to measure different echocardiographic parameters focusing on the left ventricular ejection fraction. Ninety-two percent of the patients had a cardiovascular risk factor (62.1% hypertension, 37.9% anemia, 12.1% body mass index >95th percentile, 63% serum phosphorus >5.5 mg/dL, and 57.5% calcium-phosphorus product ≥55 mg2/dL2). A diagnosis of cardiac disease was reported in 16 (24.2%) of all studied patients, the diagnostic methods used were CXR in 39 (59 %), echocardiograms in 23 (34.8%), and electrocardiograms in 21 (31.8%), left ventricular hypertrophy/ enlargement was reported in 12 (75%) of cardiac patients, congestive heart failure/pulmonary edema in 11 (68.8%) of cardiac patients, cardiomyopathy in one (6.3%) of cardiac patients and decreased left ventricular function in one (6.3%) of cardiac patients. Ninety-two percent of patients had cardiovascular risk factors. Diagnosis of cardiac disease was reported in about a quarter of all studied patients. An echocardiography reported the left ventricular dysfunction in 12 (75%) of cardiac dialysis patients. The present study stresses the importance of echocardiography as the gold standard for the diagnosis of cardiac disease in pediatric patients under maintenance HD as a high-risk population for cardiac diseases.

Study of some pulmonary function tests in Egyptian children with end-stage renal disease under regular hemodialysis in correlation with dialysis duration.

Pulmonary function tests can differentiate between obstructive and restrictive lung diseases and assess the severity of the disease in children. The aim of work was to study pulmonary function tests in children with end-stage renal disease (ESRD) undergoing hemodialysis (HD) and its correlation with dialysis duration. This study was conducted on 40 patients with ESRD on regular HD for at least six months selected from the Pediatric Nephrology unit of Pediatric Department of Tanta university hospital and 40 healthy children as a control group. All participants were subjected to full history taking, thorough clinical examination, laboratory investigation: arterial blood gases and pulmonary function tests, including resting spirometry included measurement of lung volumes. There were significantly lower forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, peak expiratory flow rate, and forced expiratory flow in patients compared with controls and significant positive correlations between dialysis duration and both of FVC and FEV1 in studied patients. There were restrictive spirometric pattern in 30 patients (75%) with ESRD under regular HD and mixed obstructive and restrictive pattern in 10 patients (25%) with highly significant differences between patients and controls regarding patterns of spirometry. There was impairment of lung function in patients with chronic renal failure undergoing HD predominantly of the restrictive pattern. Children with ESRD under regular HD should undergo pulmonary function tests as follow-up investigation to detect associated pulmonary complications included obstructive, restrictive, or mixed patterns of impaired pulmonary function.

Early predictors of cardiac dysfunction in Egyptian children with chronic kidney disease.

BACKGROUND: Cardiovascular morbidity (CVM) is the main etiology of mortality in children and adolescents with chronic kidney disease (CKD). CKD associated cardiovascular mortality is more common in children with diastolic cardiac dysfunction which was considered as an early indicator for death, while increased left ventricular mass (LVM) is a strong independent risk factor for these patients. Vitamin D deficiency was previously studied as one of the risk factors for CVM. AIM: The aim of the work was to investigate the relationship between biomarkers of mineral bone disorder including serum 25(OH) Vitamin D3 (25-OH D3), phosphorus and calcium × phosphorus (Ca×Po4) product with diastolic cardiac function and LVM in children and adolescents with CKD. SUBJECTS AND METHODS: This was a cross-sectional observational study. Participants were classified into two groups: Group I including 86 pediatric patients with CKD (stages 4 or 5) and Group II including 40 healthy controls. Group I was subdivided into IA included children with diastolic dysfunction and IB included cases without diastolic dysfunction. 25-OH D3 level was measured by enhanced chemiluminescence method and intact parathyroid hormone (iPTH) by electrochemiluminescence method. Parameters for diastolic function and LVM were assessed by Doppler echocardiography, tissue Doppler imaging, and M-mode echocardiography. RESULTS: 25-OH D3 level was significantly lower in Group I when compared to Group II. Diastolic dysfunction was present in 48.8% of the studied patients and was significantly associated with increased serum phosphorus and calcium-phosphorus product but not with decreased level of 25-OH D3. There was a significant positive correlation between LVM and iPTH. CONCLUSIONS: Hyperphosphatemia and high Ca×Po4 product were considered of prognostic value as they predict early diastolic dysfunction and increased LVM in children with CKD.

Cardioprotective Effects of Spirulina Therapy in Children With Beta-Thalassemia Major.

INTRODUCTION: Cardiac failure in children with Thalassemia major (TM) is the major cause of death due to iron overload. Spirulina is a micro alga with proven anti-inflammatory, antioxidant and may have a cardioprotective effect. AIM OF THE WORK: The aim of this study was to evaluate the possible beneficial effect of spirulina supplement in TM children. SUBJECT AND METHODS: It is an interventional study carried out in 60 children with TM and 30 healthy children matched for age and sex as control. Both groups received spirulina supplement at a dose of 250 mg/kg/d for 3 months. 2D Echo, Tissue Doppler, and speckle tracking imaging (STI) were done for all the studied cohort before and after the 3-month duration of spirulina supplement. RESULTS: There was significant improvement in hemoglobin level at the end of 3-month period (8.27±1.3 vs. 9.023±1.7; P <0.033) with decrease the frequency of blood transfusion in TM patients (66.6% vs. 40% required transfusion at interval less than 2 wk). Left ventricle global longitudinal strain (LVGLS) significantly improved after 3-month period (-21.7±4.64 vs. -24.67±4.478; P <0.002). CONCLUSIONS: Spirulina supplement has possible beneficial effect in minimizing the frequency of blood transfusion as well as cardioprotective effect against cardiac damage in TM patients.

Myocardial Function in Egyptian Pediatric Patients With Acute Nephritic Syndrome.

INTRODUCTION: Acute nephritic syndrome (ANS) is the most common cause of hypertensive heart failure in pediatric population. There are few publications on myocardial evaluation using electrocardiographic and echocardiographic data in pediatric patients with ANS. This study aimed to evaluate myocardial function by electrocardiography and 2-dimensional echocardiography in Egyptian pediatric patients with ANS. MATERIALS AND METHODS: Sixty children with ANS were included and subjected to clinical, laboratory, electrocardiography for corrected QT interval, and 2-dimensional echocardiographic study on admission, and repeated at 6 and 12 weeks to measure left ventricular ejection fraction, left atrium-aorta ratio, and the ratio of peak early filling (E wave) to late diastolic filling (A wave) velocities (E/A ratio). RESULTS: Prolonged corrected QT interval was reported in 22 patients (36.7%), of whom 18 had hypertension. Fourteen patients (23.3%) had left ventricular ejection fraction below 60%. The same children also had left atrium-aorta ratios more than 2 and E/A ratios more than 2. Left ventricular ejection fraction became within normal values by 6 weeks in 12 patients, and 2 become normal by 3 months of follow-up. 4 of 14 children with low left ventricular ejection fraction (28.6%) had normal arterial blood pressure. All of the 14 children completely recovered within 3 months. CONCLUSIONS: Myocardial dysfunction in the acute phase of ANS was alleviated in almost all children within 12 weeks. Although elevated blood pressure was the commonest etiology of congestive heart failure in children with ANS, the impact of primary myocardial functional disturbance could also be put into consideration.

Heat shock protein 60 as a biomarker for acute kidney injury secondary to septic shock in pediatric patients, Egyptian multicenter experience.

Acute kidney injury (AKI) is an independent predictor of morbidity and mortality for critically ill children at pediatric Intensive Care Units (PICU). It is proposed that heat shock protein 60 (HSP60) may be either a biomarker or a co-factor of survival in PICU. The aim of this work is to assess plasma levels of HSP60 in critically ill pediatric patients with AKI secondary to septic shock within the first 24 h of admission. This study was carried out on 120 pediatric patients admitted to PICUs of four university hospitals. They were divided into Group 1 included 60 patients meeting the criteria of AKI Network and septic shock, the second group included 60 critically ill patients without AKI or septic shock and the third group was 60 healthy children as controls. HSP60 levels were measured in the plasma using a commercially available ELISA and difference between groups were analyzed with a Kruskal-Wallis one-way ANOVA. P <0.05 was considered significant. There was highly significant increase in plasma levels of HSP60 in Group 1 (median 25.85 ng/mL) compared to both Group 2 (median 6.15 ng/mL) and healthy controls (median 4.35 ng/mL) (P <0.001). At a cut-off value ≥10 ng/mL, HSP60 sensitivity for prediction of cases with AKI secondary to septic shock was 96.67% with specificity 86.67%, positive predictive value 87.9%, negative predictive value 96.3%, AUC 0.993. HSP60 levels are significantly elevated in pediatric patients in Group 1 when compared to Groups 2 and 3. Hence, HSP60 may play a role in the pathogenesis of sepsis in pediatric patients.

Study of glucocorticoid receptors in T lymphocytes (CD3/GCR) as predictor of steroid responsiveness in Egyptian children with idiopathic nephrotic syndrome.

Little was known about the relationships between the T lymphocytes (CD3+), expression of glucocorticoid receptors (GCR) and the response to GC treatment in children with the idiopathic nephrotic syndrome (INS). Our objective was to determine the relation between steroid responsiveness and GCR expression in T lymphocytes. The present study was carried out on 80 children with new-onset INS admitted in Pediatric Nephrology Units of Zagazig and Tanta University Hospitals and on 40 healthy children of the same age and sex who served as control group. The Subjects were subdivided into three groups as follows: Group 1 with 40 healthy children of comparable age and sex served as control group; Group 2 consisted of 60 patients diagnosed with INS with early response to steroid therapy [early responder (ER)] and Group 3 with 20 patients diagnosed with INS with late response to steroid therapy [late responder (LR)]. They were subjected to history taking, focusing on the pattern of response to steroids (ERs), clinical examination, routine laboratory investigations and the GCR/CD3% relationship. 75% of newly diagnosed INS cases were ER whereas 25% were LR. GCR/CD3% was significantly lower in LR group in comparison with ER and control groups, with a significant negative correlation between time of steroid responsiveness and GCR/CD3%. LR group showed lower GCR expression in T lymphocytes before starting therapy which may mean that GCR expression could be part of a pathophysiological mechanism of steroid responsiveness in these children and can be used as a useful diagnostic marker to predict steroid responsiveness in patients with INS.

Relation of Serum Creatinine to Sarnat Scoring and Brain Computerized Tomography of Neonates with Hypoxic Ischemic Encephalopathy. A Single-Center Experience.

BACKGROUND: It is not easy to suspect whether newly born infants diagnosed as hypoxic ischemic encephalopathy (HIE) will develop impairment of renal function, so there is an urge to scientifically research about correlations of severity of HIE, which is represented by Sarnat scoring and brain computerized axial tomography (CAT) and serum creatinine level in these newly born infants. AIM: To evaluate renal function in the form of serum creatinine levels in full-term neonates with HIE and their correlation with severity degree of HIE, which is represented by Sarnat scoring and CAT. AIM: To evaluate renal function in the form of serum creatinine levels in full-term neonates with HIE and their correlation with severity degree of HIE, which is represented by Sarnat scoring and CAT. SUBJECTS AND METHODS: This study was a case-control type. It was conducted on 72 full-term neonates who were classified into group 1, which included 36 full-term neonates who were diagnosed as HIE according to the definition of the World Health Organization and group 2, which included 36 full-term neonates who were matched for age and sex and who served as the control group. Serum creatinine levels were measured at days 1 and 7 postnatally. CAT scans were carried out for cases only. RESULTS: Serum creatinine levels were elevated in group 1 when compared to the control group at days 1 and 7 postnatally. They were significantly correlated to the Sarnat scoring system of HIE, meaning that serum creatinine levels gradually increased with the increase in severity of HIE according to Sarnat and Sarnat staging. A statistically significant difference was observed between serum creatinine levels in patients with different findings of brain CAT, meaning that more elevation in serum creatinine levels were reported with more severe cases represented by marked changes in brain CAT. CONCLUSION: Serum creatinine levels correlate with the severity of HIE of neonates according to Sarnat scoring and brain CAT.

Predictive risk factors of steroid dependent nephrotic syndrome in children.

BACKGROUND: Development of steroid dependency is one of the difficult problems in the management of children with idiopathic nephrotic syndrome, leading to increased morbidity, complications and cost of treatment. Thus, predicting early in the disease course will be useful in counseling parents and may improve treatment strategy. OBJECTIVES: To determine the clinical characteristics that can predict the development of steroid dependency early in the initial episodes of steroid sensitive nephrotic syndrome (SSNS). PATIENTS AND METHODS: The study included 52 children with SSNS. Their ages ranged from 3 to 16 years. Patients were divided into two groups. Group A consisted of 24 patients with steroid dependency or frequent relapses nephrotic syndrome and group B consisted of 28 patients with complete remission or recurrent nephrotic syndrome. Data obtained retrospectively from patients' files. RESULTS: Children who require a cumulative steroid dose equal or more than 140 mg/kg to maintain remission during the first 6 months of the disease are at high risk to require steroid sparing agents (SSA) for disease control, and who did not achieve remission by day 20 of the initial prednisone course became steroid dependent with 96% specificity but with low sensitivity (50%). All steroid dependent children in this study showed relapses associated significantly with upper respiratory tract infections. CONCLUSIONS: Cumulative steroid dose in the first 6 months of treatment and the need of more than 20 days to achieve initial remission can predict steroid dependency in children with nephrotic syndrome.

Speckle tracking evaluation of right ventricular functions in children with sickle cell disease.

BACKGROUND: Cardiac dysfunction is a risk factor for death in patients with sickle cell disease (SCD). AIM OF THE WORK: Aim of the work is to evaluate the right ventricular systolic and diastolic functions by tissue Doppler and speckling tracking imaging in children with SCD. SUBJECTS AND METHODS: Thirty children with SCD and thirty controls were subjected to clinical, laboratory evaluations, and echocardiographic study using GE Vivid 7 (GE Medical System, Horten, Norway with a 3.5-MHz multifrequency transducer) including; Two-dimensional and tissue Doppler echocardiographic study (lateral tricuspid valve annulus peak E' velocity, lateral tricuspid valve annulus peak A' velocity, E'/A' ratio, isovolumetric relaxation time, lateral tricuspid valve annulus S' and septal S' waves and peak longitudinal systolic strain [PLSS] and time to PLSS) were done in six right ventricular segments. RESULTS: There was a significant decrease in right ventricular systolic and diastolic function in patients group when compared to controls. CONCLUSIONS: Children with SCD have impaired right ventricular systolic and diastolic functions when compared to healthy children with early evaluation of the systolic dysfunction by speckle tracking imaging technique.

Histopathological patterns of renal diseases in egyptian children: A single-center experience.

The present cross-sectional, retrospective study was aimed to determine the histopathological spectrum of renal diseases in Egyptian children and to evaluate the indications, safety, and efficacy of percutaneous renal biopsy (PRB) in a large tertiary center in Egypt. PRBs performed at the Department of Pediatrics, Tanta University Hospital over a period of nine years (from January 2007 to December 2015) were included. Light microscopic (LM) examination was performed in all cases while immunofluorescence and electron microscopic examination were performed in selected cases. Two hundred and thirty renal biopsies were performed during the study duration. Nine biopsies were excluded from the study due to insufficient sample (<7 glomeruli per specimen) giving a PRB efficacy rate of 96.1%. Results of 221 renal biopsies performed on 210 patients from native kidneys were described. Ninety-seven patients were male (46.19%) and 113 were female (53.81%) with age ranging from three months to 18 years (mean 10.51 ± 3.81 years). The main indications of renal biopsy were nephrotic syndrome (NS) (43.89%), lupus nephritis (23.53%), and recurrent or persistent hematuria (10.41%). The most common finding on LM examination of renal biopsies from children with NS was minimal change disease (22.17%). Secondary nephropathies were mostly due to lupus (23.53%). IgA nephropathy was found in eight patients (3.62%). Local pain at the site of biopsy was the most common minor complication seen postbiopsy (60.58%). Transient gross hematuria was seen in 13 patients (5.88%) without urinary retention. Major complications that required surgical intervention or blood transfusion did not occur. NS was the main indication and minimal change disease was the most common histological finding of renal biopsies from Egyptian children. Complications and efficacy of renal biopsy procedure were comparable to that reported from developed countries.

Evaluation of the coronary circulation and calcification in children on regular hemodialysis.

BACKGROUND: The objective of this study was to evaluate the coronary circulation and calcification in children with end-stage renal disease (ESRD) on hemodialysis. METHODS: A total of 50 children with ESRD and 50 healthy controls were enrolled in the study. Cardiac functions and coronary blood flow were evaluated with conventional and tissue Doppler echocardiography. Coronary artery calcification (CAC) was evaluated using high-resolution multidetector computed tomography (CT). RESULTS: The hyperemic coronary flow volume (CFV) and coronary flow reserve were significantly lower in the patient group than in the controls, while there was no significant difference in the baseline CFV between the two groups. Hypertension was present in 60% and CAC was observed in 20% of the children in the patient group. CAC was present in 30% of the children in the hypertensive subgroup. The left ventricle myocardial performance index (LV MPI), CAC score, duration of hypertension and level of diastolic blood pressure were independent predictors of the coronary blood flow, and LV MPI, serum parathyroid hormone, duration of dialysis and E'/A' mitral valve were independent predictors of coronary calcification. CONCLUSION: High diastolic blood pressure, long duration of hypertension, high LV MPI and increased CAC scores are independent risk factors for impaired coronary blood flow in children with ESRD.

Assessment of physical and psychosocial status of children with ESRD under regular hemodialysis, a single centre experience.

BACKGROUND AND OBJECTIVES: Children with end stage renal disease (ESRD) under regular hemodialysis suffer from various health problems that result either from the sequelae of disease itself or its various lines of therapy. The aim of this study is to clarify biodemographic characteristics, common complaints, and physical, and psychosocial status of children with ESRD under regular maintenance hemodialysis. PATIENTS AND METHODS: This study was conducted on forty children (13 males, 17 females) aged 6-16 years with ESRD under regular hemodialysis, selected from the Pediatric Nephrology Unit at Tanta University Hospitals. Three structured questionnaires were used that measured the biodemographic data of children and their parents, common complaints before and after the onset of hemodialysis, and a physical and psychosocial status assessment sheet comprising of nutritional habits, sleeping patterns, daily physical activities, school achievement, the emotional, behavioral and social aspects of children, and different social relationships. RESULTS: Most children with ESRD exhibited abnormal nutritional habits, disturbed sleep, decreased physical daily activities, impaired school achievement, and changing emotions and behaviors, and depressed social relationships. CONCLUSION: Common adverse effects of ESRD and hemodialysis in our center are inadequate nutritional status, abnormal sleep patterns, decreased physical activity, low school achievement, and psychosocial deterioration. RECOMMENDATIONS: Great efforts on the part of parents, pediatric nephrologists, nurses, psychologist, and school teachers are needed to improve the physical and psychosocial health of dialysis patients and thereby improve their quality of life.

Pediatric trauma BIG score: Predicting mortality in polytraumatized pediatric patients.

BACKGROUND: Trauma is a worldwide health problem and the major cause of death and disability, particularly affecting the young population. It is important to remember that pediatric trauma care has made a significant improvement in the outcomes of these injured children. AIM OF THE WORK: This study aimed at evaluation of pediatric trauma BIG score in comparison with New Injury Severity Score (NISS) and Pediatric Trauma Score (PTS) in Tanta University Emergency Hospital. MATERIALS AND METHODS: The study was conducted in Tanta University Emergency Hospital to all multiple trauma pediatric patients attended to the Emergency Department for 1 year. Pediatric trauma BIG score, PTS, and NISS scores were calculated and results compared to each other and to observed mortality. RESULTS: BIG score ≥12.7 has sensitivity 86.7% and specificity 71.4%, whereas PTS at value ≤3.5 has sensitivity 63.3% and specificity 68.6% and NISS at value ≥39.5 has sensitivity 53.3% and specificity 54.3%. There was a significant positive correlation between BIG score value and mortality rate. CONCLUSION: The pediatric BIG score is a reliable mortality-prediction score for children with traumatic injuries; it uses international normalization ratio (INR), Base Excess (BE), and Glasgow Coma Scale (GCS) values that can be measured within a few minutes of sampling, so it can be readily applied in the Pediatric Emergency Department, but it cannot be applied on patients with chronic diseases that affect INR, BE, or GCS.