Growth in children with chronic renal faliure and after transplantation

This study aimed at studying the relation between height, glomerular filtration rate [GFR] and hormonal alteration in children with chronic renal failure [CRF] on regular hemodialysis [HD] and the possible role of normal graft function, after kidney transplantation, in this respect. The study population comprised 18 children with CRF on HD with mean age of 10.56 +/- 3.08 years and 16 children with normal graft function [mean age 11.06 +/- 3.19]. Mean duration on HD was 14.72 +/- 7.73 months for CRF group. Mean interval after transplantation was 1.97 +/- 0.9 years for the group of functioning grafts. Ten normal healthy children of matched age and sex served as controls. All patients were subjected to assessment of growth parameters including height, expressed as standard deviation scores [HtSDS] for chronological age, measurement of serum growth hormone [hGH] and serum parathormone [PTH] by radioimmunoassay. Growth performance was evaluated twice: at the start of the study and after a period of one year. The overall growth retardation in children with CRF on HD corresponded to -3.16 +/- 0.43 [mean SDS for height]. Children with normal graft function had a mean HtSDS of -2.54 +/- 0.29. Growth retardation remained a critical complication after kidney transplantation despite the statistically significant improvement observed compared to the group of children with CRF [P< 0.001]. Our results confirmed that impaired HtSDS with children with CRF correlates with the duration on hemodialysis [r = -0.728, P< 0.001]. There was a significant correlation between GFR and PTH level [r = -0.750, P< 0.001] in children with CRF. Our series of children with CRF had a positive correlation between their SDS for height and GFR [r =0.760 with P<0.001]. Both categories with CRF and with normal graft function had significantly higher levels of both serum hGH and PTH compared to controls [P<0.001], while CRF children had significantly higher serum levels of both hGH and PTH compared to those with normal graft function [P<0.008 and P<0.001 respectively]. Our results support the possibility that growth retardation in children with CRF despite the normal or elevated hGH level may be explained by the presence of peripheral insensitivity to the action of hGH

Evaluation of renal glomerular and tubular markers in type I diabetics without clinical proteinuria and relation to B-cell function

To evaluate the value of microalbuminuria, urinary B2 microglobulin [B2M] and urinary N-acetyl B-D-glucosaminase [NAG] in the assessment of renal glomerular and/or tubular impairment in type 1-insulin dependent diabetic patients without clinical proteinuria and to try to clarify the relationship of these parameters with the occurrence of diabetic nephropathy and with the pancreatic B-cell function; 30 insulin dependent diapetic patients and 10 healthy normal controls were selected. Urinary C-peptide was measured in 2 hours urine collection after oral glucose load. Serum and urinary B2M, microalbuminria, urinary NAG, serum and urine creatinine and blood glucose were measured to both subjects and controls. A significant reduction in the level of C-peptide among diabetics was evident [P < 0.001]. A highly significant increase in microalbuminuria urinary B2M and urinary NAG was observed in diabetics[P < 0.001]. The incidence of abnormal increase in microalbuminuria was 80%, urinary B2M was 73. 3% and urinary NAG was 46. 67%. Mixed type proteinuria with high levels of both microalbuminuria and B2M was observed in 59.97% of diabetics. Microalbuminria was inversely related to urinary C-peptide. These data suggests that an early impairment might develop in glomeruli and/or tubules in type 1 diabetics before the occurrence of overt nephropathy and the measurement of Microalbuminria, urinary B2M and NAG are reliable methods to detect this early damage before the development of irreversible diabetic nephropathy

Microalbuminuria of incipient nephropathy in type 2 diabetics: Effect of pentoxifylline

Twenty six non insulin dependent diapetic [NIDD] patients and ten healthy controls are included in the present work. To all subjects included in the study, urine analysis for clinical proteinuria has been done. None of the diabetics have overt nephropathy [all with normal serum creatinine and no macroalbuminuria]. All patients have neither pyuria, nor evidence of cardiovascular disease. All patients are maintained on the same oral hypoglycaemic drug previously taken before the study. Fasting and two hours postprandial blood glucose, serum creatinine, urinary creatinine, microalbuminuria in ug albumin/mg urinary creatinine were determined to all subjects and contrals. Trental was adminstered in a dose of 800 mg for fifteen days to all diabetics and all the parameters are determined after the drug intake. The results revealed no significant change in microalbuminuria after pentoxifylline [Trental] therapy. However, individual data revealed that in twelve diabetics the microalbuminuria decreased and in fourteen diabetics the microalbuminuria increased after Trental. The increase in microalbuminuria has been explained on the basis of the mechanism of action of Trental on large vessels of the kidney while the decreasing effect of Trental on the microalbuminuria is probably due to its action on the red cell rheology with improvement of the microcirculation. The work clarifies that Trental has neither deleterious effect on the kidney function nor on the glucose tolerance. It is sugggested that Trental is useful on long term use in incipient diabetic nephropathy