Introduction: Cardiovascular complications are common among chronic kidney disease (CKD) patients.Aim of work: To assess left ventricular geometric abnormalities in CKD patients and their relation to serum NT pro BNP levels. Patients and methods: This study included 21 patients with different stages of chronic renal insufficiency (CRI); (11 males, 10 females ; age 2-12 years), 30 patients with end stage renal disease (ESRD) on regular heamodialysis (16 males, 14 females; age 5,4-16 years) and 20 healthy children as control group (12 males, 8 females; age 2.3-11). All subjects were subjected to echocardiography and serum measurement of BNP by enzyme linked immunosorbent assay.Results: Abnormal left ventricular geometry patterns were seen in 17/21 (81%) CRI patients in the form of concentric hypertrophy in 8 patients, eccentric hypertrophy in 8 patients and concentric remodling in one patient. In ESRD patients 28/30 (93%) had abnormal left ventricular geometry patterns (23 had concentric hypertrophy, 4 had eccentric hypertrophy and one patient had concentric remodling). Mean NTpro BNP level was significantly higher in ESRD (182.49 ± 136.57) as compared to CRI (29.72 ± 34.77) and control group (1.13 ± 2.97) p< 0.001. In all CKD patients, significant positive correlations were found between NT pro BNP level and each of hypertension, left ventricular mass (LVM), LVM2.7, LVM2, relative wall thickness (RWT) and serum creatinine (r=0.46, 0.35, 0.46, 0.47, 0.42, 0.29; p= 0.0007, 0.01, 0.0007, 0.0005, 0,0002, 0,04, respectively.Conclusion: Abnormal LV geometry patterns are found in all stages of CKD. Routine echocardiography is recommended even in early stages of CKD.