Study about Cardiomyopathy in children in kasr alaini

study about cardiomyopathy in children in kasr alaini with renal impairement

1. وَأَن لَّيْسَ لِلإِنْسَانِ إِلاَّ مَا سَعَى * وَأَنَّ سَعْيَهُ سَوْفَ يُرَى * ثُمَّ يُجْزَاهُ الْجَزَاءَ الأوْفَى . صدق الله العظيم سورة النجم (الايات 39-41)

2. By Esraa Abd El Nasser Mohamed M.B.B.Ch ., Pattern of Renal Diseases in Children Attending Pediatric Nephrology Outpatient Clinic of Cairo University Children’s Hospital

3. Under Supervision of Prof. Dr. Manal El Sayed Abd El Meguid Professor of Pediatrics Faculty of Medicine, Cairo University   Dr. Shaimaa Sayed Mohamed Lecturer of Pediatrics Faculty of Medicine, Cairo University

4. Special thanks to Prof, Prof. Dr. Aml Mostafa , Professor of Pediatrics, Cairo University, Prof. Dr. Osama Ezzat , Professor of Pediatrics , Beni Sweif University

5. Introduction

6. The pattern of childhood renal disease varies from one geographic region to another even within the same country. This variation is affected by factors such as genetic predisposition, environmental background, and to a large extent the level of awareness. Introduction

7. Renal diseases are important causes of morbidity and mortality among children worldwide, more so in the developing countries where such factors as late presentation, limited diagnostics, and therapeutics among others contribute to the high burden and poor outcome of renal diseases in children. Introduction

8. The use of routine prenatal ultrasonography has created a new challenge to the pediatrician due to the increase in the diagnosis of congenital anomalies of the kidney and urinary Tract (CAKUT). Pediatricians should have knowledge of the modes of presentation of renal disease in children, and a high index of suspicion in patients with asymptomatic disease. Introduction

9. Aim of the Work

10. Aim of the Work The aim of the study was to identify the pattern of renal diseases among children attending pediatric nephrology outpatient clinic of Cairo university Children’s Hospital and their comorbidities .

11. Patients and Methods

12. Patients and Methods

13. Patients and Methods All patients who met the inclusion criteria, their files revised for History Comprehensive physical examination - Anthropometric measurement Blood pressure reading Laboratory investigations - CBC - Renal function tests - Serum electrolytes - Calcium profile - Blood gases - Urine analysis Imaging - Pelviabdominal US

14. Results

15. Demographic data of study population Results Gender Count (%) Male 235 (64.4%) Female 130 (35.6%) Age (years)   Mean±SD 7.01±3.61 Median (IQR) 7.00 (4-10) Range 0.50-13.00

16. Etiology of kidney disease in whole study population Results   Count % Etiology Glomerular 134 36.7% CAKUT 111 30.4% Tubular 60 16.4% Thrombotic microangiopathy 19 5.2% Stones 16 4.4% Cystic kidney disease 11 3.0% Systemic 8 2 .2 % Recurrent UTI 6 1.6%

17. Complications reported in the study population Results Complications Count % HTN Yes 175 47.9% No 190 52.1% Growth impairment Yes 156 42.7% No 209 57.3% Anemia Yes 223 61.1% No 142 38.9%

18. Comparison between different etiologies regarding incidence of anemia Results Etiology Count Percentage Etiology Count Percentage P value CAKUT Yes 80 72.1 Non- CAKUT Yes 143 56.3 0.004 No 31 27.9 No 111 43.7 Tubular Yes 38 63.3 Non tubular Yes 185 60.7 0.697 No 22 36.7 No 120 39.3 Glomerular Yes 73 54.5 Non glomerular Yes 150 64.9 0.048 No 61 45.5 No 81 35.1 Recurrent UTI Yes 4 66.7 Non recurrent UTI Yes 219 61 1 No 2 33.3 No 140 39 Stones Yes 5 31.2 Non stones Yes 218 62.5 0.012 No 11 68.8 No 131 37.5 Cystic kidney disease Yes 9 81.8 Non – cystic kidney disease Yes 214 60.5 0.214 No 2 18.2 No 140 39.5 TMA Yes 11 57.9 Non TMA Yes 212 61.3 0.769 No 8 42.1 No 134 38.7 Systemic Yes 3 37.5 Non systemic Yes 220 61.6 0.27 No 5 62.5 No 137 38.4 CAKUT & cystic kidney disease   Yes 89 73 Non CAKUT & cystic kidney disease Yes 134 55.1 0.001 No 33 27 No 109 44.9

19. Comparison between different etiologies regarding incidence of growth impairment Results Etiology Count Percentage Etiology Count Percentage P value CAKUT Yes 68 61.3 Non-CAKUT Yes 88 34.6 > 0.001 No 43 38.7 No 166 65.4 Tubular Yes 35 58.3 Non- tubular Yes 121 39.7 0.008 No 25 41.7 No 184 60.3 Glomerular Yes 30 22.4 Non glomerular Yes 126 54.5 > 0.001 No 104 77.6 No 105 45.5 Recurrent UTI Yes 2 33.3 Non recurrent UTI Yes 154 42.9 1 No 4 66.7 No 205 57.1 Stones Yes 4 25 Non-stones Yes 152 43.6 0.142 No 12 75 No 197 56.4 Cystic kidney disease Yes 10 90.9 Non-cystic kidney disease Yes 146 41.2 0.001 No 1 9.1 No 208 58.8 TMA Yes 5 26.3 Non-TMA Yes 151 43.6 0.137 No 14 73.7 No 195 56.4 Systemic Yes 2 25 Non-systemic Yes 154 43.1 0.475 No 6 75 No 203 56.9 CAKUT & cystic kidney disease Yes 78 63.9 Non-CAKUT & cystic kidney disease Yes 78 32.1 > 0.001 No 44 36.1 No 165 67.9

20. Relation between different etiologies and CKD stages Results   CKD stage 1-3 CKD stage 4 & 5 P value Count % Count % Glomerular Yes 129 96.3% 5 3.7% < 0.001* No 192 83.1% 39 16.9% Tubular Yes 58 96.7% 2 3.3% 0.023* No 263 86.2% 42 13.8% CAKUT Yes 87 78.4% 24 21.6% < 0.001* No 234 92.1% 20 7.9% Recurrent UTI Yes 6 100.0% 0.0% 1 No 315 87.7% 44 12.3% Stones Yes 16 100.0% 0.0% 0.235 No 305 87.4% 44 12.6% Cystic kidney disease Yes 4 36.4% 7 63.6% < 0.001* No 317 89.5% 37 10.5% TMA Yes 14 73.7% 5 26.3% 0.064 No 307 88.7% 39 11.3% Systemic Yes 7 87.5% 1 12.5% 1 No 314 88.0% 43 12.0%

21. Relation between complications and CKD stages Results   CKD stage 1&2 CKD stage 3 CKD 4 & 5 P value Count % Count % Count % BP interpretation Normal 100 76.9% 14 10.8% 16 12.3% 0.774 Elevated 44 73.3% 7 11.7% 9 15.0% HTN 130 74.3% 26 14.8% 19 10.9% Anemia Yes 149 66.8% 39 17.5% 35 15.7% < 0.001* No 125 88.0% 8 5.6% 9 6.4% Growth impairment Yes 89 57.1% 32 20.5% 35 22.4% < 0.001* No 185 88.5% 15 7.2% 9 4.3%

22. Correlation between GFR with hemoglobin level Results

23. Correlation between GFR with anthropometric data Results

24. Post hoc pair wise comparisons between categories of SBP percentile regarding GFR Results

25. Conclusion

26. Conclusion

27. Recommendations

28. Recommendations