The Egyptian Society Of Pediatric Nephrology & Transplantation (ESPNT)GEGET1687-613X14220191230Correlation between Neutrophil Gelatinase‐associated Lipocalin and highly sensitive C reactive protein as markers for early detection of acute kidney injury in neonatal sepsis.166703110.21608/geget.2019.67031ENMoftahRabeeaPediatric department, Al-Azhar University, Cairo, Egypt.MohamedAbdelkerimPediatric department , Al Azhar University, Cairo, Egypt.IbrahimMetwalyClinical Pathology department, Al Azhar University, Cairo, Egypt.SayedElsisiPediatric department, Al Azhar University, Cairo, Egypt.Journal Article20191206Introduction<br /> Sepsis is the commonest cause of neonatal mortality and is responsible for 30-50% of total neonatal deaths each year in developing countries. Neonatal sepsis is one of the commonest causes of Acute Kidney Injury (AKI) in newborns and it is associated with poor outcomes.<br /> <br /> Aim of the study<br /> To investigate the value of Neutrophil Gelatinase-associated Lipocalin and highly sensitive C reactive protein as markers for early detection of acute kidney injury in neonatal sepsis.<br /> <br /> Patients and Methods<br /> This prospective study was conducted on 50 neonates admitted to the Neonatal Intensive Care Unit with neonatal sepsis at our university hospital (GI) and 30 apparently healthy neonates matched for gestational age and weight as a control group (GII). The septic group (GI) included all neonates (age 5-28 days) with neonatal sepsis and were classified into two subgroups according to the presence of AKI. After detailed history and complete clinical examination, all cases were subjected to the following investigations:<br /> CBC, ABG, blood culture, serum electrolytes and creatinine, CRP, hs-CRP and NGAL.<br /> <br /> Results<br /> Only 64%of all septic cases showed positive qualitative CRP (> 6mg/L) while 86% of them showed positive hs-CRP of ( > 0.5mg/L)<br /> with highly significant differences (p < 0.001). Blood culture was positive only in 52% of cases. In this study, hs-CRP was<br /> significantly higher in septic neonates with AKI (27 cases) than those without AKI (16 cases) (p < 0.001). NGAL level was<br /> significantly higher in septic neonates than the control group (p < 0.001). Also NGAL level was markedly elevated in septic cases with AKI compared to non AKI subgroup with highly significant differences (p < 0.001).There was a positive correlation between NGAL and hs-CRP in septic cases with AKI.<br /> <br /> Conclusion<br /> Hs-CRP was proved to be very useful biochemical marker for early detection of neonatal sepsis compared to qualitative CRP. Serum NGAL and hs-CRP can be considered as very useful biochemical markers for early detection of AKI in septic neonates before any rise in serum creatinine.https://geget.journals.ekb.eg/article_67031_d69afd086e56e317dc751c732b2a6d20.pdfThe Egyptian Society Of Pediatric Nephrology & Transplantation (ESPNT)GEGET1687-613X14220191201Diabetic nephropathy and type 1 diabetes mellitus: what is new?7116703210.21608/geget.2019.67032ENSalwaSwelamPediatrics departement, Faculty of Medicine, Minia University, Minia, EgyptHendMonessDepartment of Clinical Pathology, Faculty of Medicine, Minia university, Minia, EgyptJournal Article20191118Introduction<br /> Diabetic nephropathy is the leading cause of renal failure in developed and developing countries. Earlier, more sensitive and specific markers of kidney damage might help diagnose and treat diabetic nephropathy at an earlier stage to prevent the progression to renal failure.<br /> <br /> Aim of the study<br /> Is to detect early changes in glomerular basement membrane in children with type1 diabetes mellitus.<br /> <br /> Patients and Methods<br /> This study included 170 children, 120 with diabetes mellitus type1 and 50 apparently healthy children serving as controls. The study and control group were subjected to complete history taking, through clinical examination. They were also subjected to some laboratory investigations including renal function tests, glycosylated haemoglobin (HbA1c), urinary albumin excretion by detecting albumin creatinine ratio (ACR), glomerular filtration rate and urinary podocalyxin (U- PCX) by EIA.<br /> <br /> Results<br /> Our study showed that urinary podocalyxin in diabetic children and adolescents was significantly higher than the control group (P < 0. 000), and it correlated positively with glycosylated haemoglobin (HbA1c) and albuminuria (r = 0. 577 and P < 0. 02) and (r = 0. 554 and P < 0. 000). Our results showed that microalbuminuric children had highly significant U- PCX than normoalbuminuric ones.<br /> <br /> Conclusion<br /> We conclude that urinary podocalyxin could be more sensitive and specific marker of kidney damage than microalbuminuria and thus it could be a useful biomarker for detecting early diabetic nephropathy. Also, U-PCX correlate positively with HbA1c concluding that hyperglycaemic state may cause glomerular damage in early stage of diabetic nephropathy and that duration of diabetes may not play a role in that process.<br /> https://geget.journals.ekb.eg/article_67032_7c568e23ce6698befd75ee1fcb27a14c.pdfThe Egyptian Society Of Pediatric Nephrology & Transplantation (ESPNT)GEGET1687-613X14220191201Diagnostic value of urinary interleukin-6 in urinary tract infection in children.12196703310.21608/geget.2019.67033ENHudaMarzoukKasr Al Ainy School of Medicine, Pediatric department, Cairo University, Cairo, Egypt.EmadGhobrialKasr Al Ainy School of Medicine, Pediatric Department, Cairo University, Cairo, Egypt.MervatKhorshiedKasr Al Ainy School of Medicine, Clinical Pathology department, Cairo University, Cairo, Egypt.SafaaSamuelDepartment of Pediatrics, Ministry of Health, Cairo, EgyptJournal Article20191216 <br /> Introduction<br /> Urinary tract infection (UTI) is the second most common bacterial infection in children.<br /> <br /> Aim of the study<br /> To estimate the value of urinary Interleukin-6 (IL-6) in diagnosis of UTI in children and also if it can differentiate between upper and lower UTI.<br /> <br /> Patients and Methods<br /> This study included 80 children, divided into 40 patients suffering from UTI and 40 healthy children served as a control group. Patients were classified into acute pyelonephritis (n=22) and lower UTI (n=18). Urine IL-6 was measured by enzyme-linked immune- sorbent assay (ELISA) technique.<br /> <br /> Results<br /> Urinary IL-6 was significantly higher in patients with UTI than control group (p value <0.001) and also it was significantly higher in upper than lower UTI cases (p value <0.001).<br /> <br /> Conclusion<br /> Urinary IL-6 level is a reliable diagnostic tool for early identification of UTI in febrile children. The study confirms usefulness of Urinary IL-6 level is a reliable diagnostic tool for early identification of urinary IL-6 to differentiate between upper and lower UTIs.<br /> https://geget.journals.ekb.eg/article_67033_07cfafe9312d74eb6ea52ec4ee2fb8d7.pdfThe Egyptian Society Of Pediatric Nephrology & Transplantation (ESPNT)GEGET1687-613X14220191201Effect of galactose on proteinuria in pediatric steroid resistant nephrotic syndrome20246703510.21608/geget.2019.67035ENAhmedHassanPediatrics department, Children Hospital, Ain Shams University, Cairo, Egypt.0000-0002-5179-9233IhabElhakimPediatrics department, Children Hospital, Head of Pediatric Nephrology Unit, Ain Shams University, Cairo, Egypt.0000-0001-7453-1582MohammedElshenawyPediatrics department, Children Hospital, Ain Shams University, Cairo, Egypt.Journal Article20191220Introduction<br /> Proteinuria in steroid resistant nephrotic syndrome (SRNS) is associated with permeability factor (PF). Galactose has been shown to bind with PF, preventing its interaction with podocyte glycocalyx, and oral administration of galactose may lead to reduction of proteinuria.<br /> <br /> Aim of the study<br /> To study the effect of galactose on proteinuria in pediatric patients with steroid-resistant <br /> nephrotic syndrome.<br /> <br /> Patients and methods<br /> A prospective pilot clinical trial was conducted to investigate the effect of oral galactose on <br /> proteinuria in children with SRNS. Seven pediatric subjects with idiopathic SRNS were treated with <br /> oral galactose (0.2 g/Kg/dose twice daily) for 16 weeks. Monitoring parameters of improvement include clinical; vital signs, weight, absence of edema, frequency of albumin infusion, number of relapse, hospital admission and laboratory; 24 hour urine protein, serum albumin and serum creatinine. <br /> <br /> Results<br /> Study included seven patients, three of them showed clinical and laboratory improvement from the start till the end of therapy. One patient showed only clinical improvement from the start till the end of the therapy. Another patient improved clinically only after 8 weeks and then improved clinically and laboratory after 16 weeks. One patient was late responder (improved clinically and laboratory after 16 weeks) and one did not improve both clinically and laboratory all through the study.<br /> <br /> Conclusion<br /> The addition of galactose to conventional therapy in idiopathic SRNS is associated with clinical &/or laboratory improvement in most cases. Galactose intake may decrease the need of albumin infusion in resistant cases and hence, need for hospital admission.<br /> https://geget.journals.ekb.eg/article_67035_b4d413bde22df4fc673e1f5b9e30845e.pdfThe Egyptian Society Of Pediatric Nephrology & Transplantation (ESPNT)GEGET1687-613X14220191201Electroencephalogram findings in chronic kidney disease25316703610.21608/geget.2019.67036ENSalwaSwelamPediatrics departement, Faculty of Medicine, Minia University, Minia, Egypt.SamirAbdallahPediatrics departement, Faculty of Medicine, Minia University, Minia, Egypt.DoaaMahrousPediatrics departement, Faculty of Medicine, Minia University, Minia, Egypt.Journal Article20191116Introduction<br /> Uremic polyneuropathy is a common complication of chronic renal in sufficiency in the peripheral nervous system (PNS). EEG is useful in assessing patients with uremic encephalopathy and in monitoring their progress. EEG in CKD usually shows irregular low voltage with slowing of the posterior dominant alpha rhythm and occasional theta bursts. Prolonged bursts of bilateral, synchronous slow and sharp waves or spike waves are characteristic. These changes stabilize with dialysis when adequate, efficient of long duration and sufficient for appropriate urea clearance. However many patients as, hypertensive patients, those with associated electrolyte disorders (hypocalcemia, hypo or hypernatremia, hypo or hyperkalemia, intractable acidosis) will not show any improvement.<br /> <br /> Aim of the study<br /> To investigate the Electroencephalogram findings in different stages of chronic kidney disease.<br /> <br /> Patients and Methods<br /> In this prospective observational study, we included 54 children (22 males and 32 females) with different stages of chronic renal diseases (from stage 1 to stage 5, either in pre dialytic or dialytic stage), with mean age of 12.2 years & a ra (4-18).<br /> <br /> Results<br /> Stages (3, 4 & 5) had significantly higher Theta pattern record compared to stages 1 & 2 (33.3% of both stage 3 & 4 and 50% of stage 5 cases have shown theta records. Increased frequency of asymetry and sharp waves with progress of CKD to a maximum in dialytic stage.<br /> <br /> Conclusions<br /> Pediatric patients with chronic kidney diseases have obvious distinct EEG deviations from normality which increase with the progress<br /> https://geget.journals.ekb.eg/article_67036_03f96e3ad88f4d280bb2d91b2669f4aa.pdfThe Egyptian Society Of Pediatric Nephrology & Transplantation (ESPNT)GEGET1687-613X14220191201Malnutrition Markers and Serum Ghrelin Levels in Hemodialysis Patients32406703710.21608/geget.2019.67037ENEzzatAminPediatrics department, Faculty of Medicine, Zagazig University, Egypt.AzzaEldesoukyPediatrics department, Faculty of Medicine, Zagazig University, Egypt.HalaAbdel- AzizClinical department, Faculty of Medicine, Zagazig University, Egypt.OlaRagebMinistry of health, Pediatrician. Zagazig, Egypt.Journal Article20191116Introduction<br /> Malnutrition is the major co-morbid condition of patients on dialysis, regular monitoring of nutritional status should be apart of treatment .Ghrelin is a stomach-derived hormone<br /> <br /> Aim of the Study<br /> The aim of this study is to investigate the changes in levels of serum ghrelin in end-stage renal disease patients receiving dialysis treatment and its relationship to some malnutrition markers.<br /> <br /> Patients and Methods<br /> This prospective case control study was conducted in the Nephrology Unit of our University Hospital, 46 patient were included in this study ; they were classified into two groups , cases group comprised 23 children with chronic <br /> renal failure on regular hemodialysis control group comprised 23 children matched for age and sex body mass idex , Malnutrition inflammation score, total protein, albumin, blood urea nitrogen, creatinine, total iron binding capacity, ferritin, and cholesterol., Serum ghrelin levels<br /> <br /> Results<br /> Ghrelin was significantly higher in cases than control mean 4769.0957 , Ghrelin sensitivity was 87.0 % , specificity was 78.3 % , positive predictive value was 80.0 % , negative predictive value was 85.7 % and accuracy was 82.6 % , cutoff value was >2070. Cases showed significant higher than control mean levels for ferritin, cholesterol and lower Hemoglobin, total iron binding capacity and total proteins. Cases showed significant high level of Ghrelin compared to normal control.<br /> <br /> Conclusion<br /> Ghrelin level increased in Hemodialysis patient, increased Ghrelin level might be related to anorexia . It could be used as a prognostic nutritional marker.<br /> <br /> https://geget.journals.ekb.eg/article_67037_4175b7766e9807e376990c9bd466b5b5.pdfThe Egyptian Society Of Pediatric Nephrology & Transplantation (ESPNT)GEGET1687-613X14220191201Urinary Interleukin‐6 as biomarker for diagnosis of acute pyelonephritis in children41466703810.21608/geget.2019.67038ENAshrafAbdelaalUrology department, Faculty of Medicine, Benha University, Benha, Egypt.0000-0001-5993-7752Abd AlHamedAlHamsharyPediatrics department, Faculty of Medicine, Benha University, Benha, Egypt.OsamaEl ShaerClinical Pathology department, Faculty of Medicine, Benha University, Benha, Egypt. UniversityMustafaKhalilUrology department, Faculty of Medicine, Benha University, Benha, Egypt.AmrYounesPediatrics department, Faculty of Medicine, Benha University, Benha, Egypt.Journal Article20191127Introduction<br /> Urinary Interleukin-6 (IL-6) a pleiotropic cytokine with pro-inflammatory and immune-regulatory functions is a key mediator of inflammation in children with Urinary tract infection (UTI).<br /> <br /> Aim of the study<br /> The aim of this study is to estimate the role of urinary IL-6 (UIL-6) in diagnosis of acute UTI in children and its usefulness in differentiation between upper urinary tract infection (UUTI) (pyelonephritis) and lower urinary tract infection (LUTI) (cystitis).<br /> <br /> Patients & Methods<br /> This study conducted on a total 56 children divided into 36 patients suffering from UTI with mean age 4.3 ± 3.1 and 20 apparently healthy children age and sex matched with the cases. All patients were subjected to routine investigation and urine IL-6 assay.<br /> <br /> Results<br /> Urinary IL-6 was significantly higher in patients with UTI than control group, Sensitivity was 94.4 %, specificity of 92.1%, positive predictive value was 85%, negative predictive value was 97.2% anddiagnostic accuracy was 92.8% and the best cut off value >17 pg/ml. Also Urinary IL-6 was significantly higher in acute pyelonephritis (APN) in comparison to lower UTI cases and there was a positive correlation between urinary IL-6 level and fever, CRP, and leukocyte count [r = 0.623 P = 0.006, r = 0.816, P < 0.001 and r = 0.688, P < 0.002 respectively]<br /> <br /> Conclusion<br /> Urinary IL-6 level may considered as a reliable biochemical marker to determine the severity of renal injury in APN as well as outcome of pediatric patients<br /> <br /> https://geget.journals.ekb.eg/article_67038_3bcced5aaf4e666d63288c9f70921ebd.pdfThe Egyptian Society Of Pediatric Nephrology & Transplantation (ESPNT)GEGET1687-613X14220191201Renal angina validation of acute kidney injury in critically ill children47536704110.21608/geget.2019.67041ENMonaGehadPediatrics department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.0000-0002-1005-6046DoaaYoussefPediatrics department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.SaadMansourPediatrics department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.AmalEl_shalBiochemistry department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.AhmedOsmanPediatrics department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.YousifYousifPediatrics department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.FaikaArabPediatrics department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.Journal Article20191123Introduction<br /> Since the initial (renal angina) RA proposal in 2010 and Developing (renal angina index) RAI, increased in prediction of severe (acute kidney injury) AKI at the time of intensive care unit admission. New biomarkers such as Cystatin C has better performance in prediction of sever AKI in critically ill children with different illness.<br /> <br /> Aim of the study<br /> To test the hypothesis that combination of Cystatin C in patients with renal angina improves the prediction of AKI.<br /> <br /> Patients and methods<br /> In this study 53 critically ill children admitted to the pediatric intensive care unit in our university hospital, Measurement of urine Cystatin C by ELISA kit and in combination with the RAI which is calculated in each critically ill child for severe AKI. Also statistical analysis was done in days (0-3-7).<br /> <br /> <br /> Results<br /> Cystatin C has a sensitivity of 76.5%, a specificity of 95%, positive predictive value of 83.3% negative predictive value of 92.7% and accuracy of 90.6% regarding prediction of AKI. Combination of both cystatin C and RAI has a sensitivity of 92.3%, a specificity of 97.5%, positive predictive value of 92.3%, and negative predictive value of 97.5% and accuracy of 96.2% regarding prediction of AKI.<br /> <br /> Conclusions<br /> This study shows that combination of Cystatin C with RAI improves detection ability of AKI in critically ill children.<br /> https://geget.journals.ekb.eg/article_67041_6e380e0dc3282036963aeb3a87329c05.pdfThe Egyptian Society Of Pediatric Nephrology & Transplantation (ESPNT)GEGET1687-613X14220191201Vitamin D level in nephrotic syndrome, Factors of impact?53616704210.21608/geget.2019.67042ENHudaMarzoukKasr Al Ainy School of Medicine, Pediatric department, Cairo University, Cairo, EgyptEmadGhobrialKasr Al Ainy School of Medicine, Pediatric department, Cairo University, Cairo, Egypt.MervatKhorshiedKasr Al Ainy School of Medicine, Clinical Pathology department, Cairo University, Cairo, Egypt.MonaMohammedPediatrics department, Ministry of Health, Cairo, Egypt.Journal Article20191213Introduction<br /> Nephrotic syndrome (NS) usually responds to steroid therapy; however, the majority of children relapse, resulting in prolonged and repeated courses of steroid therapy. Vitamin D is a vital component of bone metabolism and calcium homeostasis. Maintenance of adequate levels of vitamin D is recommended to maintain good bone health and other organ systems of NS patients. The study aimed to assess serum 25 (OH) D levels in children with NS, compare its level with healthy age and sex-matched controls and compare its level in different types of NS.<br /> <br /> Patients and Methods<br /> It was a cross-sectional study for measuring 25(OH) D levels in 60 patients with NS and 60 apparently healthy children, to be compared as controls. Nephrotic patients were classified as steroid sensitive (20 cases) steroid dependent (20cases), and steroid resistant (20 cases). Serum 25-hydroxyvitamin [25(OH) D] was measured using Enzyme Linked Immune <br /> Sorbent Assay (ELISA) technique.<br /> <br /> Results<br /> Serum 25(OH) D was significantly lower in NS patients than control group (p<0.001).Steroid resistant nephrotic syndrome (SRNS) patient group showed the highest drop than the other 2 groups (p<0.001). There was significant negative correlation between vitamin D level and number of relapses, 24 hours urinary proteins and serum cholesterol.<br /> <br /> Conclusion<br /> It is recommended that NS patients especially on long term steroid therapy should undergo regular follow up of vitamin D level and early prophylactic supplementation with calcium and vitamin D should be advised.<br /> https://geget.journals.ekb.eg/article_67042_8974f657568ca90baad38ce8b78f2e31.pdf