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OBJECTIVES Chronic kidney disease (CKD) is a common cause of restless leg syndrome (RLS). RLS is under-recognized, misdiagnosed and undertreated disorder in our locality. In this study, we aimed to determine the prevalence of RLS due to CKD and its predictors. METHODS This cross-sectional study included 520 patients [male = 200; female = 320; age: 48.45 ± 3.63yrs; uremia duration: 6.44 ± 1.65yrs; CKD5D = 400; CKD3D = 120). RLS diagnosis was done by clinical interviewing according to International RLS Study Group criteria. All underwent detailed biochemical testing and iron and ferritin levels' measurements. Insomnia, depression and anxiety severities were assessed using insomnia sleep index (ISI), Beck Depression Inventory (BDI-II) and State-Trait Anxiety Inventory for Adults (STAI-AD) scales. RESULTS RLS was found in 22.31% [ESKD = 26%, CKD3D = 10%]. Insomnia, depression and anxiety were found in 76.15%, 91.15% and 44.23%, respectively. Insomnia was correlated with depression (r = 0.488, p = 0.001) and anxiety (r = 0.360, p = 0.006) but not RLS. Multiple linear regression analysis showed that ESKD (OR = 3.8, 95%CI = 2.5-8.5, p = 0.001), inadequate dialysis (OR = 4.6, 95%CI = 3.5-8.6, p = 0.001), hyperparathyroidism (OR = 5.1, 95%CI 3.2-13.7, p = 0.0001) and peripheral neuropathy (OR = 5.6, 95%CI = 3.8-12.8, p = 0.0001) were independently associated with RLS. CONCLUSION The prevalence of RLS with CKD is 22.31%. It is 2.6 times more frequent and severe with ESKD compared to CKD3D. It seems that RLS may occur early with CKD and becomes worse with progressive kidney impairment. Also, insomnia, depression and anxiety are common with CKD, however, their severities were not correlated with RLS. Predictors for RLS were ESKD, inadequacy of dialysis, hyperparathyroidism and peripheral neuropathy.

Previous studies have identified frequent comorbid neuropsychiatric disorders and conditions in adults with thyrotoxicosis. These studies are scarce or even lacking in pediatric population. This work aimed to study the behavior of children and adolescents with Graves’ disease (GD). This study included 35 children with GD (boys = 15; girls = 25; mean age: 11.45±1.50yrs) and 40 healthy children (boys = 20; girls = 20; mean age: 12.54±1.62yrs). Behavior was assessed using Child Behavior Checklist (CBCL). Children with GD were assessed during periods of thyroid hormone elevation (active disease) and normalized thyroid hormones (with anti-thyroid drugs or ATDs). Compared to healthy children, patients during periods of thyroid hormone elevation (74.29%) and normalized thyroid hormones (31.43%) had higher frequencies of behavioral abnormalities and scorings of total CBCL scale (P = 0.01; P = 0.04, respectively) and its subscales’ [Anxious/Depressed (P = 0.02; P = 0.04), Withdrawn/Depressed (P = 0.03; P = 0.04) and Somatic Complaints (P = 0.03; P = 0.127) and Social (P = 0.01; P = 0.225), Thought (P = 0.01; P = 0.128) and Attention (P = 0.01; P = 0.01) problems], indicating internalizing and externalizing problems. The majority of patients had at least two different behavioral problems. Marked improvement was found during period of normalized thyroid hormones (P = 0.001). Correlation analyses showed significant associations between total CBCL scoring and age at onset (P = 0.01; P = 0.001) and lower concentrations of thyroid stimulating hormone (TSH) (P = 0.001; P = 0.04) and higher concentrations of free thyroxine (fT4) (P = 0.01; P = 0.02), triiodothyronine (fT3) (P = 0.01; P = 0.03) and thyrotropin receptor antibodies (TRAbs) (P = 0.001; P = 0.01) during periods of thyroid hormone elevation and normalized thyroid hormones, respectively. Multiple linear regression analysis showed that "at presentation" lower concentrations of TSH (P = 0.001; P = 0.03) and higher concentrations of fT4 (P = 0.001, P = 0.01), fT3 (P = 0.01; P = 0.06) and TRAbs (P = 0.001; P = 0.001) were predictors of behavioral problems during periods of active disease and normalized thyroid hormones. We conclude that GD is associated with higher frequencies and severities of anxiety, depression and inattention during periods of thyroid hormone elevation as well as normalized thyroid hormones with ATDs. Therefore, early diagnosis and optimizing management are required to improve children’s social life.

Background: Early detection of kidney affection in sys-temic lupus erythrematosus patients and proper monitoring of lupus nephritis activity is very important step in improving lupus nephritis outcome. Urinary kidney injury molecule-1 is considered as a promising biomarker of kidney injury.Aim of Study: Use of urinary kidney molecule-1 as an early biomarker of lupus nephritis in systemic lupus erythre-matosus patients and detection of correlation between U– KIM-1 and disease activity lupus nephritis.Methods: Our study included 45 systemic lupus patients and 15 controls. Patients divided into 3 groups ; group A (SLE without lupus nephritis), group B (SLE with inactive lupus nephritis) & group C (SLE with active lupus nephritis). All patients included in this study are subjected to the following investigations: Urinary Kim-1, complete blood picture, serum urea &creatinine, urine analysis, 24 hour urinary proteins, estimated GFR by CKD-EPI Creatinine Equation, complement 3 & 4, serum albumin, Anti-dsDNA antibody & ESR.Results: Generally U-KIM-1 was significantly higher in our patients with SLE compared with the healthy control group. Also, patients with nephritis had significantly higher level in comparison to those without nephritis. Our study also showed that patients with active nephritis had significantly higher level of U–KIM-1 in comparison to those patients with inactive nephritis. U-KIM-1 had negative moderate significant correlation with eGFR [–0.62 (0.001)], and Complement C3 [–0.51 (0.001)] and had positive moderate significant corre-lation with serum creatinine [0.44 (0.001)], and renal SLEDAI [0.62 (0.001)]. There was also a strong positive significant correlation between U–Kim-1 and 24h-urinary proteins col-lection [0.71 (0.001)]. Although there was negative weak correlation between U–Kim-1.Conclusion: Urinary kidney injury molecule -1 (KIM–1) is considered a promising biomarker that can be used in early detection and initial diagnosis of renal affection in systemic lupus erythrematosis, monitoring of activity of lupus nephritis. And hence, can also be used in monitoring response to treat-ment.Recommendation: Wider studies are recommended to detect cut off points of U-Kim-1 in lupus nephritis & active lupus nephritis.

Background Although obstructive sleep apnea syndrome (OSAS) has been associated with chronic kidney disease CKD, there are little data about early screening of renal affection in OSAS patients. Aim of the work To evaluate renal function in OSAS patients with or without diabetes mellitus (DM) using blood indices [mean platelet volume (MPV) and red cell distribution width (RDW)] and serum neutrophil gelatinase associated lipocalin (NGAL) as early markers of kidney injury. Patients and methods This case control analytic study was designed to enroll 20 OSAS patients with DM, 20 OSAS patients without DM, and 20 non OSAS diabetic patients as control group. All patients underwent full over-night attended diagnostic polysomnography. Those with AHI ≥5 were considered to have OSAS. Laboratory parameters including complete blood count with MPV and RDW, serum glucose, urea, creatinine, Hemoglobin A1c, urine albumin creatinine ratio UACR and serum NGAL were done to all enrolled participants. Results Urine albumin creatinine ratio UACR ≥ 3 mg/mmol was found in 11 (55%) of OSAS diabetic group, 6 (30%) of non diabetic OSAS group and in 11 (55%) of D.M group. Both diabetic and non diabetic OSAS patients had significantly higher RDW and NGAL compared to non OSAS diabetic. The diabetic OSAS group had also significantly higher serum urea and creatinine compared to DM group. In OSAS patients, RDW had significant positive correlation with UACR. Meanwhile both RDW and NGAL were determined to have significant positive correlation with desaturation index during sleep, but not correlated to AHI. Conclusion Renal impairment is common in OSAS patients but more frequent if associated with diabetes mellitus. RDW% can be used as simple screening test for early detection of renal injury in OSAS patients with or without diabetes mellitus.

Background: Chronic kidney disease (CKD) is a common disease in clinical practice and increases the risk for acute coronary syndrome, and there are little data about the relation between the elevation of troponin T levels and morbidity and mortality outcomes in CKD patients. The aim of the work: is to estimate the appropriate highly-sensitive troponin T average value in CKD patients who presented with acute coronary syndrome and its relation to the outcome. Patients and methods: The study included 60 patients who were sub-divided into two groups, First group: 30 patients with CKD and ACS as the study group, the second group: 30 patients with ACS without evidence of CKD as the control group. Measurement of the highly sensitive troponin T level after 1-3 hours of the onset of chest pain and calculation of the estimated glomerular filtration rate (eGFR) was done. Results: The mean levels of the highly sensitive troponin T levels were significantly higher in patients with CKD and ACS with p value less than 0.05 and there was significant statistical difference between mean of HS Trop T of patients with ACS and complications and those without (4.3 ± 1.1 vs. 2.1± 0.9 ng/ml; P= 0.03). Also, mean of HS Trop T of patients with ACS that were died was significantly higher than those were improved (2.91± 0.6 vs. 3.1 ± 0.9; P = 0.02) Conclusion: There is a direct negative correlation between the levels of highly sensitive troponin T and estimated glomerular filtration rate, but there is a direct relation between the higher level of highly sensitive troponin T and mortality and morbidity rates in patients with ACS and CKD. The specificity of the highly sensitive troponin T decreases with the decreased estimated GFR in ACS and CKD patients resulting in higher level of highly sensitive troponin T required for the diagnosis of NSTE-ACS.

Background: A large proportion of cardiovascular mortality in dialysis patients is caused by sudden death that is related to the dialysis procedure. Parameters of heart rate variability, P wave duration and dispersion and rate corrected QT and QT dispersion are readily used to assess cardiac electrical stability. However, there are relatively few data discussing the factors associated with arrhythmia in dialysis patients. Methods: The study included 30 patients on regular haemodialysis. All patients had full history taking (age, sex, duration of haemodialysis in months and smoking history), clinical examination, laboratory investigations (serum Mg, K, Na and complete blood picture), echocardiography and 24-hours Holter recording. Results: The study included 30 patient on regular haemodialysis (mean duration 30.9±13.2 months), 53.3% males with mean age 43.9±10.1 years. All ECG and Holter derived parameters showed statistically significant changes during haemodialysis. There were increase in P wave duration and dispersion, rate corrected QT interval and QT dispersion and decrease in heart rate variability, that are arrhythmogenic. Moreover, the incidence of both supraventricular and ventricular ectopics increased during dialysis. Smoking and long term dialysis were associated with more arrhythmia risk. Conclusions: Patients on regular haemodialysis are susceptible to cardiac arrhythmias. The process of haemodialysis itself is arrhythmogenic. Smoking and long term haemodialysis are associated with higher incidence of cardiac electrical instability.