Numerous complications related to the respiratory system occur in patients with chronic renal disease such as : pulmonary oedema, fibrinous pleuritis, sleep a pnea, dialysis associated hypoxaemia and pulmonary embolism. Some of these complications are related to alterations in volume status, plasma oncotic pressur, bone and mineral metabolism, concomitant heart failure and altered immune functions in such patients.
So the role of HRCT chest in pediatric patients with ESRD is evolving for early detection and management of the pulmonary complications of ESRD because the appearance of HRCT has led to decrease in the number of lung biopsies in such patients .
This study was carried in the pediatric dialysis unit of kasr al-aini children hospital (Abualrish – Monira ). It included one group of twenty seven patients on regular hemodialysis for at least one month, their age ranged from 4-18 years, their GFR was < 15 ml / m2/ min
All patients were subjected to :
Full history taking, clinical examination ,clinical assessment for nutritional status in addition to routine laboratory investigations such as kidney functions, liver functions ,serum electrolytes, calcium profile, complete blood count, x ray chest echocardiography , HRCT chest and assessment of dialysis adequacy through calculation of Kt/v.
In our patients there was a significant decrease of all of the anthropometric measurements together with progressive loss of final adult height which significantly affects their sense of well being and quality of life .
Also renal osteodystrophy which is a major complication of ESRD and was found in 30% of our patients that could be due to hyperparathyroidism , reduced amount of active it D and chronic metabolic acidosis. Anaemia was found in 66% of our patients as detected clinically and by laboratory means despite being on regular treatment for chronic renal anaemia .
Regarding the routine laboratory workup, there was a highly decreased levels of BUN and serum creatinine post dialysis while serum calcium , phosphorus and serum sodium were within normal values but serum potassium and serum alkaline phosphatase were high between our study group.
Volume overload manifestations were found in our patients in different distribution and also hypertension was found in 74% of them who was on antihypertensive drugs .
Cardiac findings were fond in 59% of our patitns as detected by echocardiographic examination, like: dilated, hypertrophic cardiomyopathy, valvualr dysfunction, ventricular hypertrophy and aortic arch anomalies.
HRCT parenchymal chest findings were present in 70% of our patients and there was a significant correlation between these findings with clinical chest findings .
Cardiac findings were present in HRCT chest in 23% of our patients and there was a highly significant correlation between HRCT cardiac findings and the echocardiographic findings.
Also HRCT bony findings were present in 41% of our patients and there was a significant correlation between these findings and the calcium profile of our patients .
Concerning dialysis a dequacy in our study represent with Kt/v of our patients was 2.1 in comparison to the standard Kt/v of 1.2-1.3 also there was a significant correlation between parenchymal chest findings in HRCT chest and Kt/v in our patients .
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