الفهرس 
ENDOTHELIAL SYSTEMOnly 14 pages are availabe for public view
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Abstract
SUMMARY and CONCLUSION
Vascular diseases are a major cause of morbidity and mortality in ESRD patients.
Patients on HD therapy are believed to be at increased risk for atherosclerotic CVD because of traditional risk factors as well as several factors closely related to uremia with inflammation and endothelial dysfunction identified as a significant contributors to the excessive CVD mortality.
Circulating endothelial cells are increased in a variety of conditions with an activated endothelium. For more than 30 years ago, endothelial cells have been known to circulate in the blood stream, but only recently have these circulating endothelial cells been recognized as potentially reflecting the endothelial state, increasing markedly in conditions associated with endothelial injury.
Our aim was to evaluate the efficiency of measurement of CECs in evaluating endothelial injury in pediatric patients with ESRD and on regular HD treatment.
This study was conducted on 30 patients with ESRD on regular HD as group A (18 males 60% and 12 females 40%), their ages ranged from 11 to 18 years (152.31), the duration of illness ranged from 1-10 years (42.69).
The cause of ESRD in these patients were variable 20 (66.7%) suffered from CGN, 2 (7%) suffered from CGN and renal anomalies, 4 (13%) suffered from VUR and 4 (13%) suffered from OU.
This group was sub-classified into 15 normotensives (group Ia) and 15 hypertensives (group Ib). These sub-classified groups were conducted to different procedures in HD session [15 (50%) on pump rate 250 ml/min and 15 (50%) on pump rate 300ml/min], [15(50%) on filer 0.7m2, 15(50%) on filter 1m2], [13 (43.3%)] on fistula needle 16G and 17 (56.7%) on fistula needle 17G], and [11 (36.7%)] with complicated AV fistula.
8 (53.3%) of the hypertensive group on ACEIs only, 5 (33.3%) on ACEIs+ CCB,1 (6.6%) on ACEIs + BB and the last one (3.3%) on ACEIs+ -blocker.
Group B Comprised 30 healthy children 15 males (50%) and 15 females (50%) as a controls groups. Their ages ranged between 11-18 years (151.94).
All patients were subjected to history taking with special emphasis on duration of illness, past history of symptoms of vascular diseases, hypertension, anti hypertensives drugs, Epo dose, cardiovascular examination and, AV fistula complications.
Laboratory investigations done to patients and controls included hemogram (Hb, TLC, and platelets count.), routine laboratory work-up (s.creatinine, blood urea, s.ca, s.p, s.albunin, s. iron, s. ferritin and iPTH), lipid profile (TG, total cholesterol, HDL-C LDL-C and risk ratio), high sensitivity CRP and circulating endothelial cells by flowcytometry using FITC labelled monoclonal IgG, antibody.
In our study we found a significantly higher pre and post dialysis count of CECs as compared to healthy volunteers. Also the post-dialysis count was significantly higher than the predialysis one in our patients group.
Median value of CECs in our controls was (7032.38 cell/ml) as compared to (280158.78 cell/mL) and (630210.02 cell/mL) in both pre and post dialysis samples respectively.
Similar results were found in our hypertensives and normotesnives patients when compared to controls.
In our study a correlation was done between CECs count and the additive effect of a group of variables namely lipid profile (TG, cholesterol, HDL-C, LDL-C and risk ratio) and renal profile (ca, p, ca x p, and iPTH) and each had a significant direct correlation with CECs when presented together despite of absence of statistical affection when presented alone.
A similar positive significant correlation was found between the cumulative effect of lipid profile with blood pressure on CECs count. On the other hand, the effect of different dialysis parameters and blood pressure together had no statistically significant correlation with CECs.
In our work, study of high sensitivity CRP among our patients and controls revealed a significantly higher CRP among patients than controls. A similar finding was noted between hypertensives, normotesnives and controls while no significant variation in CRP was found between hypertensives and normotensive.
In our study, a comparison between patients with ESRD and controls was done regarding to various clinical and routine laboratory work up which proved to be non significant except for significantly lower weight among patients than controls and significantly higher SBP, DBP, mean BP and HR among patients than controls.
Similar findings were noted on comparing hypertensives, normotesnives, and controls.
Also a significantly lower Hb concentration in comparison to a significantly higher platelets count, s.creatinine, bl.urea, s.phosphorus, Ca x p, s.iron, s. ferritin and iPTH were found in patients than controls
As regards s.albumin, it was comparable in patients and controls.
Similar results were found on comparing hypertensives and normotesnives with controls.
As regards lipid profile, there were a significantly higher TGs, total cholesterol, LDL.C and risk ratio in comparison to a significant lower HDL.C in patients than controls.
In our work a comparison was done between hypertensives and normotesnives as regards details related to the dialysis process (duration of dialysis, pump rate, urea reduction ratio, Kt/v, life span of AV fistula and total dose of EPO) and all proved to be insignificant.
Correlations between CECs and different clinical and laboratory parameters were done among different groups and proved to be insignificant except for in patients CECs had direct correlation with age and duration of illness while in controls CECs had inverse correlation with s.ca and s.albumin.
Finally, we concluded that in pediatric patients on regular HD had higher median value of CECs than controls. CECs assessment might be a good and early marker of vascular endothelium injury. ACEI might improve endothelial cell dysfunction in pediatric patients on HD.