الفهرس 
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Abstract
Uremia is a clinical syndrome associated with fluid, electrolyte, hormone imbalances and metabolic abnormalities, which occurs in parallel with deterioration of renal function. Dysfunction of the peripheral nervous system induced by uremia commonly occurs in patients with end-stage renal disease and is an indication to initiate dialysis. However, patients already being adequately dialyzed are also at some risk.
The aim of this study is electrophysiological screening of end stage renal failure children undergoing hemodialysis for the presence of peripheral and autonomic neuropathy at Alexandria university children’s hospital.
The study included thirty five children divided into two groups:
group 1: Twenty end stage renal failure children on hemodialysis;14 males (70%) and 6 females (30%) .Their age ranged from 6 - 16 years, with a mean age of 9.95 (± 3.1) years.
group 2: Fifteen healthy children of matched age, sex and general constitutional status .They were a control group for routine nerve conduction studies and sympathetic skin response.
The following assessments were done to group (1) children: laboratory investigations; Urea, Creatinine, Sodium, Potessium, Calcium, Albumin, Uric acid, Phosphorus, Parathormone, Hemoglobin, Bicarbonate, Blood PH, measures of adequacy of dialysis and neurological examination.
Both groups were assessed for: Routine nerve conduction studies including; Sensory nerve conduction study (ulnar nerve in the upper limb, sural nerve in the lower limb), motor nerve conduction study (ulnar nerve in the upper limb, posterior tibial nerve in the lower limb), needle electromyography of vastus medialis and tibialis anterior muscles and sympathetic skin response of upper limbs and lower limbs.
Routine nerve conduction studies revealed that 75% of children in group (I) had evidence of Peripheral neuropathy; 65% of them had subclinical peripheral neuropathy. Sensorimotor neuropathy was the most common type representing 60% of children with uremic peripheral neuropathy. Regarding the type of pathology of peripheral neuropathy in the affected children; Axonal degeneration with secondary demyelination type was the predominating type present in 11 children (73.4%). 8 children (40%) had evidence of autonomic neuropathy by sympathetic skin response. No significant relation was detected between presence of peripheral neuropathy or autonomic neuropathy and duration of renal disease, duration of hemodialysis nor adequacy of dialysis. Level of parathormone hormone was significantly higher in children with peripheral neuropathy than those with no peripheral neuropathy. Urea and parathormone hormone levels were significantly higher in children with autonomic neuropathy than children without autonomic neuropathy.
It has been shown that subclinical peripheral neuropathy is common among children with chronic renal failure on heamodialysis. Nerve conduction study is a promising tool for diagnosis of subclinical peripheral neuropathy. Uremic peripheral neuropathy is significantly related to increased parathormone hormone level and isn’t related to duration of renal disease, duration of hemodialysis nor adequacy of hemodialysis. Sympathetic skin response is a confirmatory method for diagnosis autonomic neuropathy. Uremic autonomic neuropathy is significantly related to increased urea and parathormone hormone level but isn’t related to duration of renal disease, duration of hemodialysis nor adequacy of dialysis.