الفهرس 
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Abstract
Chronic renal impairment is the decrease is renal function. Chronic renal failure is a term defining patients with stage 5 CKD treated with dialysis or kidney transplantation.
Main complications of CKD & ESRD (stages 5 CKD) include: cardiovascular disease, anemia, growth retardation, hypertension, vascular calcification and stiffness, renal osteodystrophy and others.
Chronic Kidney Disease patients are under conservative therapy and diet regimen. Options for renal replacement therapy for ESRD include the following: kidney transplantation, HD, PD and supportive therapy in the form of drugs for hypertension, anemia and diet control. Hemodialysis is still the most frequently used modality for renal replacement therapy in pediatric ESRD more than PD and renal transplantation.
Anemia is an almost universal funding in patients with CKD or ESRD receiving chronic HD (CHD) and associated with increased mortality.
Treatment is based on erythropoiesis stimulating agents (ESAs) in Association with iron therapy.
If iron concentration is high, this can be toxic, and leads to iron overload disease which may be cause organ damage.
Despite the use ESAs, the anemia of CKD & ESRD can be resistant to therapy. Both absolute and functional iron deficiency along with inflammation can contribute to ESA resistance.
Hepcidin, an acute phase reactant protein produced in the liver mainly and its elimination is renal. Hepcidin is a key regulator of iron homeostasis.
Hepcidin inhibits intestinal iron absorption and iron release from macrophages and hepatocytes. Hepcidin production is increased by inflammation and high hepcidin concentration limit iron availability for erythropoiesis.
Hepcidin likely plays a major role in the anemia of inflammation and rhEPO resistance.
Determination of hepcidin levels might useful in predicting a response to EPO and iron treatment in patients with chronic diseases, anemia, as well as in the monitoring of EPO treatment.
Standard dose of HD and intensification of HD clear the hepcidin would be expected to benefit the patients with disease of hepcidin excess.
Hepcidin antagonists in future Vit. C, EPO, and monoclonal antibodies and clearance of hepcidin by HD will a beneficial treatment of hyporesponsiveness to ESA therapy in ESRD patients.
The present study was done to detect serum hepcidin level in 20 children with ESRD on regular HD in Menoufia University hospital and 10 children with CKD under conservative treatment and 10 healthy age and sex matched children were serving as controls.
All patients and controls were subjected to complete history taking and clinical examination. Laboratory assessments were done measuring Hb, CRP, ESR, serum creatinine, ferritin and hepcidin level.
The results of these studies were tabulated and statistically analysed showing the following results.
• There was significant growth retardation in patients as compared to controls. As reflected by the decline in Wt and Ht.
• There were significant decreases in Hb while CRP, ESR, creatinine, ferritin, and hepcidin level slowed a significant increase in patients than controls.
• There is a positive correlation between serum hepcidin levels and serum ferritin also and serum creatinine level. But there is a negative correlation between serum hepcidin and hemoglobin levels.
from this study we concluded that:
Hepcidin may serve as a marker for diagnosis and monitor anemia in CKD either on HD therapy or on conservative therapy.
And we recommend that:
Standard and good prescription of HD will lead to decrease hepcidin level.