الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Chronic kidney disease (CKD) is a major health problem worldwide. Although relatively uncommon in children, it can be a devastating illness with many long-term consequences. The global incidence of pediatric CKD rose slowly during the 1980s, then marginally until the first decade of the 21st century. At the same time, the prevalence of the disease has significantly increased since survival and treatment of CKD have markedly improved. The main etiologic factors of CKD in children are represented by CAKUT, steroid-resistant nephrotic syndrome (SRNS), chronic glomerulonephritis (e.g. lupus nephritis, Alport syndrome) and renal ciliopathies, that account for approximately 49.1, 10.4, 8.1 and 5.3% of cases, respectively and for more than 70% of all pediatric CKD cases when considered together Growth impairment is a common and perhaps the most visible complication of CKD in children. The degree of growth impairment increases as GFR declines, even though a significant decrease in growth was seen at all levels of kidney function. This clinical prospective descriptive study was done at AUCH during one-year period, from 1st Jan 2017 to 31st December 2017. The study included 100 patients with symptoms and signs of CKD. The aim of this work is to assess growth parameters (weight, length and BMI) in children with CKD attending the nephrology unit at AUCH. The study included 100 patients with CKD. Their ages ranged from 4 months to 18 years old with a mean ± SD (8.44±5.43), 67 patients were males and 33 patients were females. CAKUT were the most common causes of CKD in the studied patients and represent 42% of all cases. About 80% of our patients were on RRT, as 38% of them were on peritoneal dialysis, while 42% were on hemodialysis. Clinical manifestations of growth failure in the studied patients were recorded as follow: Body weight with a mean ± SD (23.59 ± 14.46) was less than 3rd percentile in 43% of the studied patients. Body height with a mean ± SD (106.2 ± 29.46) was less than the 3rd percentile in 47% of the studied patients. BMI with a mean ± SD (18.53 ± 3.98) was less than 15 kg/m² in 57% of cases and more than 18.5 in 24% of cases. ROD was a common complication of CKD as 77% of the studied patients showed variable ROD manifestations. Anemia was a common complication in children with CKD causing many adverse clinical consequences in 82% of the studied patients. Manifestations of vitamin and mineral deficiencies were recorded in 42% of the studied patients. Regarding laboratory investigations for assessment of renal function, serum electrolytes and plasma protein, we found that, BUN and serum creatinin were high in 76% and 74% of the studied patients respectively. On the other hand, hypernatremia was found in 40% of the studied patients, while 27% of them had hyperkalemia. Hypoalbuminemia and hypocalcaemia was recorded in 67% and 82% of the studied patients respectively. About 71% of the studied patients showed high phosphorus level. Regarding serum PTH level we found that 82% had secondary hyperparathyroidism. Regarding correlation studies, a significant negative correlation noticed between growth parameters (Body weight and height) from one hand, and duration of illness and number of hospital admission on the other hand. from the results and data of our study we can conclude that: CKD in childhood is a major devastating illness with many long-term consequences. CKD is identified by the presence of kidney damage, either structural or functional, or by a decline in glomerular filtration rate (GFR) below 60 ml/min/1.73 m² of body surface area for more than 3 months. Males are affected more than females.
CAKUT are the most common cause of CKD in children. Growth failure develops early in the course of CKD; a significant proportion of children presents with severe short stature. Anemia is a major complication of CKD which represents a cause of seeking medical advice in some cases. Dialysis makes it possible to continue living with end-stage kidney disease for many years or even decades. The severity of growth impairment in CKD increased with prolongation of the duration of illness and the number of hospital admission.