ABSTRACT
Background: The process of sclerosis and stiffening is the leading phenomenon of the arterial changes in uremia at young age which is usually followed by thrombus formation. Thus cardiac mortality is the main cause of death in patients with chronic kidney disease. Objectives: To study the risk factors and new markers for diagnosis and follow up of atherosclerosis in children with chronic renal failure. Methods: Fifty subjects were included in this work: 20 patients with end stage renal disease (ESRD) under regular hemodialysis (group A), 20 patients with chronic renal failure (CRF) under conservative treatment (group B) and 10 healthy age-and sex-matched children (group C). All groups were subjected to routine investigations (CBC, kidney function tests, serum albumin level, Lipid profile, serum calcium and phosphorus level) and specific investigations (serum iron and ferritin, blood parathormone level (PTH), serum homocysteine (HCy) and serum arginine level). Finally Doppler Ultrasound on the carotid arteries was done for all subjects. Results: There was a highly significant difference in urea, creatinine, Ca x P, PTH and ferritin among the three studied groups with a significant increase of all in the patients groups than in the control group. Also, there was a significant decrease of serum arginine in the patient groups than in the control group while there was a significant increase in homocysteine level in the patient groups. There was Asignificant increase in carotid intimal medial thickness (CIMT) in patients with renal failure than in the control group with mean CIMT in group A under regular dialysis (0.79 ± 0.25mm) and in group B (0.71 ± 0.18mm) compared with the control group (0.38 ± 0.05mm). There was highly significant positive correlation between CIMT and age of patients, duration of disease, serum urea, Ca x P product, serum ferritin, triglycerides and homocysteine. While there was a highly significant negative correlation between CIMT and serum arginine, there was no significant correlation between CIMT and cholesterol or LDL levels. Conclusions: There is accelerated atherosclerosis in children with chronic renal failure due to multiple risk factors. CIMT measurement can be used as an easy accurate and non-invasive method for early detection and follow up of atherosclerosis in these children.