الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Chronic kidney disease is the new term defined by the National Kidney Foundation Kidney Disease and Outcome Quality Initiative group to classify any patient who has kidney damage lasting for at least 3 months with or without a decreased GFR or any patient who has a GFR of less than 60 mL/min per 1.73 m2 lasting for 3 months with or without kidney damage.
The KDOQI group also classified CKD into five stages:
● Stage1: Kidney damage with a normal or increased GFR (90 mL/min per 1.73 m2)
● Stage 2: Mild reduction in the GFR (60 to 89 mL/min per 1.73 m2)
● Stage 3: Moderate reduction in the GFR (30 to 59 mL/min per 1.73 m2)
● Stage 4: Severe reduction in the GFR (15 to 29 mL/min per 1.73 m2)
● Stage 5: Kidney failure (GFR 15 mL/min per 1.73 m2 or dialysis)
GFR values for chronic kidney disease staging are for children older than 2 years of age because the GFR values for younger children are low due to ongoing renal maturation.
Congenital causes are responsible for the greatest percentage of all cases of chronic kidney disease seen in children. However, whereas this is the most common reported etiology from developed countries where chronic kidney disease is diagnosed in its earlier stages, infectious or acquired causes predominate in developing countries, where patients are referred in the later stages of chronic kidney disease .
The clinical management of pediatric chronic kidney disease is comprised of determining it’s severity, ameliorating risk factors for CKD progression, and detecting/treating comorbid complications that are the result of reduced kidney function. In pediatrics, the management of chronic kidney disease is not only directed toward the primary cause of chronic kidney disease but also encompasses a multidisciplinary team approach to assure normal growth,
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nutrition, neurocognitive development, educational progress, and transition to adulthood.
Carnitine is a small molecule widely present in all cells from prokaryotic to eukaryotic. It is an important element in the beta-oxidation of fatty acids.
Supplementation of carnitine has been approved by the US Food and Drug Administration not only for the treatment, but also for the prevention of carnitine depletion in dialysis patients, especially for those patients with cardiac complications, impaired exercise and functional capacities, lack of energy affecting quality of life, and increased episodes of hypotension. Moreover, in some patients, the improved stability of erythrocyte membranes may decrease erythropoietin requirements, thus, leading to a reduction of dialytic costs.
The aim of the present study was to assess total serum carnitine level in children with end stage renal disease on chronic hemodialysis.
This cross-sectional study was carried out at Menoufia university hospital from August 2017 to May 2018. It included 30 children on chronic hemodialysis and 30 control children with matching age and sex and socioeconomic status.
The study protocol was approved by the local ethics committee of the Menoufia University and written informed consents were obtained from children parents.
Patients aged between 4 and 18 years old and on regular hemodialysis were included. While patients aged more than 18 years, not on regular hemodialysis or suffering comorbidity like malignancy or received medication affect carnitine level like sodium valproate or received carnitine itself were excluded from this study.
Both cases and control were subjected to full history taking, complete physical examination and Laboratory investigations were done.
• For cases and controls: Complete blood picture, Serum urea, Serum creatinine and Total serum carnitine.
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• For cases: serum sodium level, serum potassium level, serum calcium level, serum phosphorus level, serum ferritin level and serum parathormone hormone level for cases only.
Our results showed, the mean age of cases was 12.4 years and that of the control was 12.8yrs. There was 53.3% were males and 46.7% were females in cases but in control 56.7% were male and 43.3% were female. There was statistically significant difference among case groups and control group as regard to weight and height, where weight and height are significantly lower in studied patients compared with controls, also there was highly significant difference regarding height and Body mass index , Z score plotted on WHO charts, 70 % of cases had short stature and 53.3 % of them were under weight as compared with controls 93.3 % were of average height and 93.3 % of average Body mass index. The cause of end stage renal disease in children was unknown in 43.3%, congenital anomalies of kidney and urinary tract in 26.6%, glomerulonephritis in 20% of patients and cystic kidney in 10%.
There was highly significant difference between cases and controls as regard to carnitine level and this difference showed highly significant inverse relationship with the dialysis duration and there was no relationship between total serum carnitine level and either age, sex, height, Body mass index, iron profile, parathormone level, albumin, Urea, Creatinine, Sodium, Potassium, Calcium or phosphorus.