الفهرس 
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Abstract
Chronic Kidney Disease (CKD) is a progressive loss in renal function over a period of months or a year. The two main causes of chronic Kidney Disease are diabetes and high blood pressure, which are responsible for up to two-thirds of the cases. The CKD has negative impacts on neutrophil chemotaxis, phagocytosis, and bactericidal actions and T cell function so; patients with a suppressed immune system due to CRF catch parasitic infections more easily.
Therefore, the authors intended to assess the predisposition of the population with chronic Kidney Disease in Sohag community to intestinal parasites by comparing their prevalence in patients with chronic Kidney Disease and individuals with no kidney disease.
In the present study, 100 stool samples were collected from patients who suffered from chronic Kidney Disease from Sohag Governorate hospitals and 100 stool samples from non renal apparently healthy control group from January to May 2015.
The collected samples were examined macroscopically, by direct smear. Part of each sample was also preserved in formalin 10% for further testing. Other concentration techniques used were; simple sedimentation, simple floatation, formol ether sedimentation tests. Also all samples were stained by modified Ziehl Neelsen stain for detection of oocycts of coccidia. Results were tabulated and statistically analyzed.
In the CKD group, the age of patients ranged from 20 to 70 years with the mean of 44.6 ± 20.3. Males constituted 39% of the whole patients (39 patients), while females were 61% of them (61 patients). 45 of them were from urban areas and 55 of them were from rural areas, 36 patients were Nephrotic syndrome patients and 64 were on regular dialysis. The control group was 49 males and 51 females, age ranged from 20 to 55 years old, 53of them were from urban areas and 47 of them were from rural areas.
The results revealed that the prevalence of intestinal parasitic infections was 66% (66 cases) of patients with chronic Kidney Disease and 31% of control group (31cases). chronic Kidney Disease affected the prevalence of intestinal parasitic infections with high significance (p value <0.001).
Hymenolepis nana was found in 12 % (12 cases) in patients with chronic Kidney Disease 5 of them patients with nephrotic syndrome and 7 of them haemodialysis patients. 11 cases were detected among control group. chronic Kidney Disease does not affect the prevalence of Hymenolepis nana infection. (P value 0.9).
E.histolytica was found in 11 % (11 cases) in patients with chronic Kidney Disease 2 of them patients with nephrotic syndrome and 9 of them haemodialysis patients. No case was detected among control group. chronic Kidney Disease affected the prevalence E. histolytica infection with higher prevalence in haemodialysis patients than patients with nephrotic syndrome. (P value 0.003).
G.lamblia was found in 12% (12 cases) in patients with chronic Kidney Disease 6 of them patients with nephrotic syndrome and 6 of them haemodialysis patients. 21 cases were detected among control group. chronic Kidney Disease does not affect the prevalence of G. lamblia infection. (P value 0.14).
C.parvum infection was found in 35% (35 cases) patients with chronic Kidney Disease (35cases), 13 of them patients with nephrotic syndrome and 22 of them haemodialysis patients. No case was detected among control group. chronic Kidney Disease affected the prevalence of C. parvum infection with higher prevalence in nephrotic syndrome patients than haemodialysis patients. (p value 0.000).
Cyclospora cayetanensis was found in 10% (10 cases) in patients with chronic Kidney Disease mixed with Cryptosporidium and Microsporidia infection, 3 of them patients with nephrotic syndrome and 7 of them haemodialysis patients. No case was detected among control group. chronic Kidney Disease affected the prevalence of Cyclospora cayetanensis infection with higher prevalence in haemodialysis patients than patients with nephrotic syndrome. (p value 0.004).
Microsporidia was found in 35% of mixed with Cryptosporidium infection in patients with chronic Kidney Disease 13 of them patients with nephrotic syndrome and 22 of them haemodialysis patients. No case was detected among control group. chronic Kidney Disease affected the prevalence of Microsporidia with higher prevalence in nephrotic syndrome patients than haemodialysis patients. (p value 0.000).
Gender was not a risk factor for intestinal parasites in chronic Kidney Disease patients as the prevalence of intestinal parasitic infections was (58.9%) of male patients (23 cases) in comparison to (70.4%) of the female patients (43 cases). P value wasn’t significant (p value = 0.16).
Also the prevalence of intestinal parasitic infections was 71.11% of patients with chronic Kidney Disease in rural areas (32 cases) in comparison to 61.88% of the patients with chronic Kidney Disease in urban areas (34cases) but residence was not a risk factor for intestinal parasites in patients with chronic Kidney Disease (p value < 0.3).
Age was found to be significantly associated with the intestinal parasitic infections chronic Kidney Disease patients (p value < 0.001) with the age group from 60 to 69 years having the highest prevalence. Age distribution of intestinal parasites in patients showed that 1 patient out of 4 (25%) from 20-29 years, 8 patients (33.33%) from 30-39 years, 15 patient (71.42%) from 40-49 years 37 patients (80.4%) from 50-59 years, 5 patients (100%) from 60-69 years. The highest prevalence with the age group from 60 to 69 years may be due to the long duration (years) of dialysis in haemodialysis patients or the treatment with corticosteroid therapy in patients with nephrotic syndrome which affect the immunity of patients.
Conclusions:
At the end of this study several significant relations were proved, including the relation of chronic Kidney Disease generally and acquiring intestinal parasites, nephrotic syndrome and old patients, are more liable to get infected, also they are more likely to be infected with Cryptosporidium mixed with Microsporidia infection. These proven relations lead us to an obligation for the patient, to advice him/her in the renal clinic or in hospitals they attend, to pay extra attention in their health behavior for self-cleanliness and the food they eat especially those old patients and that they have to attend the clinic as soon as any gastrointestinal symptoms occur. A guideline flier is suggested to be distributed among them advising them with the healthy way to protect themselves from the intestinal parasitic infections.
The present work unquestionably answered some targeted questions and raised few more. Some questions that need answers and are suggested by the authors as next points of research including:
• Why Microsporidia infection usually mixed with Cryptosporidium infection in patients with chronic Kidney Disease?
• The disappearance of many parasites previously well known to be endemic in the same locality (Sohag) and the rise of prevalence of others need more investigations and co-operation with the public health researchers.