Background: Fibroblast Growth Factor 23 (FGF23) is considered as a marker of progression of kidney disease. Objective: the aim of the study: is to assess the effect of administration of calcium carbonate on serum FGF23 in normophosphatemic children with early stages CKD. Patients and Methods: Forty children with early CKD were enrolled in this case-control study. The patients were randomly divided equally into two groups A and B. Group A (received daily oral calcium-carbonate as a phosphate binder) over a period of 6 months, and group B (did not receive oral phosphate binder or calcimimetics). Baseline and follow up urea, creatinine, serum phosphate, serum calcium, alkaline phosphatase, 25 hydroxy vitamin D, parathormone (PTH) and serum FGF23 were obtained at the start and at the end of the study period. Results: Group A showed a significant decrease in serum levels of P, ALP and 25 hydroxy vitamin D (p-values: <0.001, 0.003, 0.0001 respectively). Also, there was non-significant decrease of PTH and serum FGF-23 (p-values: 0.39 and 0.396 respectively). While in group B there was a significant increase in levels of phosphate, PTH and FGF23 (p-values: 0.012, <0.001, <0.001) respectively, in contrast to significant decrease in levels of serum calcium and 25 hydroxy vitamin D (pvalues: 0.033 and <0.001 respectively). Conclusion: Oral calcium-based phosphate binder has a role in decrease production of FGF23 and control secondary hyperparathyroidism in early CKD children.

Background:Sepsis is one of the major causes of neonatal thrombocytopenia. Aim of the work:To identify the frequency, severity, and clinical outcome of thrombocytopenia associated with culture-proven neonatal septicemia in the Neonatal Intensive Care Units (NICUs) of Cairo University Children's Hospitals. Methods: We conducted a retrospective cohort study that included all neonates with cultureproven sepsis and thrombocytopenia who were admitted to the NICUs over a one-year period (from January 2017 to December 2017). Thrombocytopenia was defined as platelet count less than 150x10 3 /µL. The thrombocytopenic neonates were divided into two groups according to the type of cultured bacteria (gram-positive and gram-negative). Both groups were compared regarding maternal and neonatal risk factors, onset and severity of thrombocytopenia, complications, and patient survival. Results: A total of 316 out of 2172 (total number of NICU admissions) newborns were found to have culture proven-sepsis (14.5%). The frequency of thrombocytopenia in neonates with culture proven-sepsis was 30.3% (n = 96/316). Prematurity is a risk factor for early onset sepsis with thrombocytopenia (p= 0.001). The frequency of severe thrombocytopenia is more in gramnegative sepsis than that in gram-positive sepsis at the onset of sepsis and at the lowest platelet count (p= 0.014, 0.015) respectively. The frequency of hemorrhage in neonates with sepsis and thrombocytopenia was 20.8 % (n = 20/96) and it was mainly pulmonary hemorrhage 10.4 % (n=10). The overall mortality among the study group was 40.6% (n=39/96), with a higher mortality rate (46.3%) in gram-negative sepsis with thrombocytopenia (OR 2.65, p= 0.042). Conclusion: Neonatal thrombocytopenia is a common finding in neonatal sepsis, and the frequency of severe thrombocytopenia is more in gram negative sepsis. Pulmonary hemorrhage is a common type of bleeding in thrombocytopenic neonates with sepsis. Gram-positive sepsis associated thrombocytopenia has a better prognosis than gram-negative sepsis.

Introduction: Dialysis is one of therapeutic interventions used for critically ill children .Dialysis modalities include peritoneal dialysis (PD), intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT). Aim of the study: is to describe the use of different dialysis modalities in pediatric intensive care units (PICUs) regarding their indications and outcome. Methods: The prospective descriptive study included all patients admitted to PICUs over a period of six months from November 2017 to April 2018, we obtained the indications of dialysis, type of dialysis modality received, dialysis prescription, and outcome. Results: Out of 977 patients admitted to the PICU during the study period, 44 patients (4.5%) required dialysis. Peritoneal dialysis was the most common dialysis modality used in this study (72.8%, n=32/44), CRRT was done for six patients (13.6%), and IHD was done for six patients (13.6%).The main indications of dialysis in the study group were azotemia in 25 cases (56.8%) PD was significantly less successful than IHD (p-value: 0.023), but there was no significant difference in success of CRRT over PD or IHD. The total mortality rate was (40.9% n=18), it was the highest with PD (94.4%, n= 17) and no mortality in IHD group during patients´ stay in the PICU. Conclusion: PD is the most commonly used dialysis modality in the PICU, but it has poor outcome. CRRT can improve outcome but it may be underutilized, because of the cost and the experience required. IHD is very successful in critically ill-children especially who were previously on regular HD.

Background: One of the symptoms of chronic kidney disease (CKD), especially in individuals receiving regular hemodialysis (HD), is headache.Objective: This study aims to describe the prevalence, characteristics, and consequences of headaches on children with CKD's quality of life as assessed by the Headache Impact Test-6 (HIT-6) score. Methods: The CKD group (n = 50) and the HD group (n = 50) were included in this cross-sectional comparative analysis. The prevalence, characteristics, frequency, and severity of headaches were compared between the two patient groups. Results:The prevalence and frequency of headache were significantly higher in the HD group than in the CKD group with p-values: <0.001, 0.003 respectively. Patients with headache had significantly lower GFR and serum sodium (p-values: 0.002, 0.006) but higher serum phosphate and PTH (p-values: 0.035, 0.005) than those without headache. In HD patients, The HIT-6 score was found to have a statistically significant positive correlation with serum magnesium (p = 0.012, r = 0.412) and a statistically significant negative correlation with serum sodium (p = 0.006, r: -0.474). Conclusions: Headaches are more prevalent and more frequent in CKD children on HD than in those on conservative treatment. In HD patients, lower serum sodium and higher serum magnesium increase the headache severity based on the HIT-6 score.