Musculoskeletal Ultrasound Findings in Children with End-Stage Renal Disease on Regular Hemodialysis.

Fakhreldeen, Mahmoud Mosaad; Abo EL-Hana, Nagy Mohamed; Abd Elnabi, Hend Hassan; Elkhouly, Radwa Mostafa; Hantash, Hala Ibrahim

doi:10.21608/geget.2024.406497

Musculoskeletal Ultrasound Findings in Children with End-Stage Renal Disease on Regular Hemodialysis.

Document Type : Original Article

Authors

¹ Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Egypt.

² Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Tanta University, Tanta, Egypt.

10.21608/geget.2024.406497

Abstract

Introduction: Children with chronic kidney disease (CKD) often have musculoskeletal issues, which may be attributed to either chronic kidney disease-mineral and bone abnormalities (CKD-MBD) or dialysis-associated amyloidosis (DRA).
Aim of the study: This study aimed to assess the use of musculoskeletal ultrasonography in detecting any anomalies in the musculoskeletal system of children with end-stage renal disease (ESRD) undergoing regular hemodialysis.
Methods: A retrospective cohort study was carried on twenty-five children with ESRD on regular hemodialysis for more than six months in comparison to twenty-five children with CKD on conservative treatment of matched age and sex. Patients with ESRD on regular hemodialysis < 6 months duration, patients with rheumatological diseases, patients with metabolic diseases and diabetic patients were excluded. All patients were subjected to complete history taking and complete clinical examination especially musculoskeletal system examination. Musculoskeletal ultrasound (MSUS) was performed for all patients on joints of upper and lower limbs. Serum β2 Microglobulin (β2M) was also performed by HP-AFS/3 specific protein analyzer. Another blood sample was collected for serum parathormone hormone (PTH), serum ionized calcium, serum phosphorus and serum 25-OH Vitamin D.
Results: Arthralgia, growth impairment and bone abnormalities were considerably greater in dialytic patients than in non-dialytic patients (P=0.002, P=0.001, P=0.034). Significant differences in joint number and synovitis severity were seen in the dialytic group for MSUS (P<0.001). The dialytic group had bone erosions, enthesopathy, and CTS (P=0.037). MSUS results showed a substantial positive connection with dialysis time, PTH, and β2M (P<0.001) and a negative correlation with serum ionized calcium and 25-OH Vitamin D (P<0.001).
Conclusion: Children with ESRD on regular hemodialysis had more MSUS findings than CKD children on conservative treatment, which were related to the prolonged duration of dialysis, higher levels of PTH, β2M, and lower levels of serum ionized calcium and serum 25-OH Vitamin.

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