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Background Cystatin-C (CyC) is a middle molecule that is freely filtered at the glomerulus and almost completely reabsorbed by the proximal tubules. The aim of this study was to evaluate serum CyC and its reduction ratio as a biomarker for assessing the adequacy of the hemodialysis (HD) sessions in children with end-stage renal disease on maintenance HD. We also compared levels of CyC in patients on low-flux HD (LFH) and high-flux HD (HFH). Methods Forty patients were included in the study and divided into two groups, with one group (16 patients) receiving HFH and the other group receiving LFH (24 patients) (high-flux and low-flux polysulfone filters, respectively). Before and after each dialysis session serum CyC and beta-2-microglobulin (B2M) levels were measured using an ELISA technique, and routine laboratory tests were performed for each patient. Results Pre-dialytic levels of CyC were significantly lower in the patients receiving HFH than in those receiving LFH (7.33 ± 1.35 vs. 9.73 ± 0.93, respectively; p < 0.0001). In the HFH group, post-dialytic levels of serum CyC were significantly lower than pre-dialytic levels (4.49 ± 0.71 vs. 7.33 ± 1.35, respectively; p < 0.0001). The reduction ratio (RR) of CyC was significantly higher in the HFH group than in the LFH group (38.2 ± 3.91 vs. -6.49 ± 5.05, respectively; p < 0.0001). Serum CyC level significantly correlated with B2M, urea and creatinine levels in both the LFH and HFH groups, whereas its RR significantly correlated with the RRs of urea, creatinine, and B2M in the HFH group. Conclusion The results of our study emphasize the role of CyC as a good marker for assessing the adequacy of HD sessions in children on HFH and show that the CyC RR may be used as an index of middle-molecule toxin clearance following HFH sessions., Author(s): Fatina I. Fadel [sup.1] , Abbass A. Mourad [sup.2] , Azza M. O. Abdel Rahman [sup.2] , Hafez M. Bazaraa [sup.1] , Mohamed Farouk Mohamed [sup.1] , Dalia H. [...]

Purpose 'Hockey stick incision' used in renal transplant is large enough to cause severe postoperative morbidity especially in pediatric recipients. Although epidural analgesia is known to be effective in pain control, the resulting sympathectomy might affect hemodynamics interfering with the transplant process. In our study, we evaluated the feasibility and safety of inserting an epidural catheter to the thoracic level via the caudal route, and the effect of using epidural local anesthetics at low concentrations on hemodynamics. Methods After approval from the ethical committee at Kasr Al Ainy University Hospital and consent from parents/legal guardians, sixty patients aged 3-12 years who were scheduled for renal transplant were randomly divided into two equal groups. Group I (epidural group) received continuous caudal epidural bupivacaine 0.125 % with fentanyl together with intravenous (IV) fentanyl and paracetamol. Group II (control group) received only IV fentanyl and paracetamol. Intraoperative data included heart rate (HR), mean arterial blood pressure (MAP) and central venous pressure (CVP). Postoperative variables included HR, MAP, CVP, pain score and complications. Results Threading failure via the caudal route occurred in 6.67 % of cases. Intraoperative differences in hemodynamics and CVP were not clinically significant between groups. Postoperative HR, MAP, and CVP were generally higher in the control group. Pain control was more satisfactory and postoperative complications were less in the epidural group. Conclusion Caudal epidural anesthesia in pediatric renal transplant is a valuable addition to general anesthesia as it provides stable perioperative hemodynamics, excellent postoperative analgesia and is associated with fewer complications than narcotic-dependent analgesia. Clinical trial registration number: NCT02037802, Author(s): Sherif M. Soaida[sup.1] [sup.4] , Mohammed S. ElSheemy[sup.2] , Ahmed M. Shouman[sup.2] , Ahmed I. Shoukry[sup.2] , Hany A. Morsi[sup.2] , Doaa M. Salah[sup.3] , Fatina I. Fadel[sup.3] , [...]

Introduction: Regulatory T cells (Treg) are emerging as a potential therapy to facilitate long-term allograft survival what makes identification of reliable surface markers that are selectively expressed on Treg is crucial. The aim of this study is to evaluate the regulatory and suppressive functions of CD127 in peripheral T lymphocytes of pediatric kidney transplant recipients through studying the association their frequency and the development of rejection. Material and methods: Flow cytometric analysis of peripheral blood samples for the CD127 surface marker of 50 pediatric transplant recipients and 12 healthy controls was done. Clinical, laboratory, immunosuppressive therapy data and graft function of transplant recipients were collected and correlated with their CD127 peripheral blood expression. Results: CD127 expression in transplanted children was significantly elevated than that of controls (2.76 ±3.26% vs. 0.95 ±0.94%, p = 0.042). CD 127 expression did not correlate with donor relation, cytomegalovirus infection, acute rejection episodes or type of immunosuppressive drugs (p = 0.475, 0.479, 0.678 and 0.333 respectively). Patients with chronic allograft dysfunction (CAD) had significantly lowered frequencies of CD127 compared with those with stable graft function (0.61 ±0.549% vs. 3.08 ±3.375 %, p = 0.021). Conclusions: CD127+ cells is more expressed in transplanted children with stable graft function than those with CAD which makes the regulatory role of CD127+ cells post-transplantation a subject for further researches. The negative relationship between the frequency of CD127 and CAD supposes these cells as probable candidates for allowing allograft survival. [ABSTRACT FROM AUTHOR]

Abstract Aim and Methods We investigated the association between polymorphisms of the angiotensin converting enzyme-1 (ACE-1) and angiotensin II type one receptor (AT1RA1166C) genes and the causation of renal disease in 76 advanced chronic kidney disease (CKD) pediatric patients undergoing maintenance hemodialysis (MHD) or conservative treatment (CT). Serum ACE activity and creatine kinase-MB fraction (CK-MB) were measured in all groups. Left ventricular mass index (LVMI) was calculated according to echocardiographic measurements. Seventy healthy controls were also genotyped. Results The differences of D allele and DI genotype of ACE were found significant between MHD group and the controls (p = 0.0001). ACE-activity and LVMI were higher in MHD, while CK-MB was higher in CT patients than in all other groups. The combined genotype DD v/s ID+II comparison validated that DD genotype was a high risk genotype for hypertension .~89% of the DD CKD patients were found hypertensive in comparison to ~ 61% of patients of non DD genotype(p = 0.02). The MHD group showed an increased frequency of the C allele and CC genotype of the AT1RA1166C polymorphism (P = 0.0001). On multiple linear regression analysis, C-allele was independently associated with hypertension (P = 0.04). Conclusion ACE DD and AT1R A/C genotypes implicated possible roles in the hypertensive state and in renal damage among children with ESRD. This result might be useful in planning therapeutic strategies for individual patients.