الفهرس 
Systemic disturbances in chronic renal failureOnly 14 pages are availabe for public view
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Abstract
The present study was carried out at the pediatric dialysis unit, Children Hospital, Ain Shams
University.
The subjects v.ere divided into three groups:
- group I included twenty (20) patients suffering from end stage renal disease and were under
regular hemodi alysis therapy . Their ages ranged from 6-16 years with mean age of (12.3 yrs).
13 (65%) were males while 7 (35%) were females.
group lJ included seven (7) patients und r conservative management for chronic renal failure. Their
ages ranged from 10-15 years w ith mean age of ( 13.4 yrs).
4 (57. 1%) wece males and 3 (42.9%) were females).
- group Ill (control group): This group included fif teen (15) apparently healthy children serving
as control for patients. Their ages ranged from 5 to 15 years with mean age of (10.3 yrs).
9 (60%) were males and 6 (40%) were females).
All studied cases were subjected to full history taking, thorough clinical examination, assessment
of level of depression , evaluation of
intelligence quotient and psychological condition, laboratory investigations as Hb level, serum
creatinine, serum calcium and serum alkaline phosphataSe were done for all cases. Serum aluminum
level by using flamJess atomic absorption technique was done for each case, and it was measured
before and after dialysis session in group I patients. Also we measured AL level in tap water
before and after reverse-osmosis treatment (RO).
Our results showed that serumAL level was significantly higher in group l patients (55.38 ±7.84
).Lg/L) compared to group II patients
(7.27 ±2.34 !J.g/L) and the control group (5.89 ±0.99 !J.g/L) while there
was insignificant difference in serumAL level between group II patietus and the control group. On
the other hand, AL levelin tap water (17 IJ.gfl .) was higher than the permissible range (10-15
!J.giL). After reverse osmosis (RO) treatment AL level was (3 !J.g/L), and this was within the
preferable range (<10 /-1&/L).
The mean Hb level was significantly lower in CRF patients on HD as compared to controls (6.8 ±0.98
grnldl versus 9.4 +I.l gm/dl) and their mean serum Ca level was significantly lower (8.32 ±I
.76 versus
10.1 ±0.47 mg/dl) while serum alkaline phosphatase was significantly higher in this group of
patients (314.4 ±230.1 versus 188.9 ±48.0 I.V.IL).
Patients with CRF on conservative treatment had their mean serum
Hb (6.74 ± 1.29 gm/dl) significantly lower than the control group
(9.4 :!:1.1 gm/dl) and their mean serum Ca significantly lower (8.34 ±1.03 versus I 0.1 ±0.47
mg/dl) while serum alkaline phospha taSe was significantly higher (278.0 ±247 .2 versus 188.9
+48.03 I.V.IL). There was a significant increase in creatinine level in both patient groups
compared with the control group.
On the other band. the intelligeo .:e quotient (lQ) was more compromi sed in patients with CRF
[both group 1and TT] in comparison to the control group [79.3 ±6.3 and 80.7 ±7.2 versus 94.0 ±7.6].
The results revealed that patien ts of group I had higher levels of
d!::pression (33.4 ±6.9) compared with the control group (3.1 ±1.8). A
significant positive correlation was detected between the duration of
dialysis in this.group of patients and the prevalence of depression among
them.
There was marked depression in group n (29.9 +7.1) although their
serumAL level was insignificantly different from the control.
These results further stress the role of high serum AL leve’l in those groups of patients in the
pathogenesis of anemia, booe manifestations and psychiatric disorders as depression , sleep
troubles and mental
impairment.
It 1. concluded that higher serum AL level is a constant fact in th course of chronic renal
failure specially in patienrs under regu la
hemod ialysis. So, restoring the normal safe level should be one of ou goals during the treatment
of those patients to avoid AL toxicity with it consequence complications as ir n-resistant
hypochromi c anemia, AL bone disease and AI encephalopathy.
As regard the psychological troubles in chronic renal failure, it i multifactorial affected by
chronicity of disease, application of painful dialysis procedures and repeated hospital admission.
High serum AL level is one of the important factors or may be an addin
factor for increasing already present psychological troubles.
The danger is that these psychological disorders [as depression, anxiety imelle:aua l impairment
an d sleep disorders] may have seriou consequences on the child ’s ernotioual and
personality developmen t resulting in individuals with more tendency to neurosis and learnin
difficulties.