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EgyptAim: This study aimed to assess the diagnostic value of serum cytokeratin-18 in children with chronic liver diseases (CLD) and correlate its serum level with liver histology and other liver biomarkers. Methods: This study included two groups, the first group included children with CLD and the second group included healthy matched age and gender subjects as a control group, complete history and clinical examination, and serum CK-18 was measured using the sandwich enzyme-linked immunosorbent assay technique. Results: Serum concentrations of CK-18 were significantly elevated in CLD patients with mean AE standard deviation (1070.63 AE 699.2 ng/mL) compared to healthy controls mean AE standard deviation (203.95 AE 83.57 ng/mL). CK-18 levels were associated with a change in hepatocyte and portal tract (P = 0.005) as it was elevated with cirrhosis and fibrosis stage (P = 0.02) as it was elevated with moderate and severe fibrosis than mild fibrosis, also it showed a gradual increase in accordance with child Pugh score. There was a positive correlation between CK-18 levels and Total IgG, paediatric end-stage liver disease score and model for end-stage liver disease scores, the best cutoff point of CK-18 was 624 ng/mL, with sensitivity 93.06%, specificity 62.5% and diagnostic accuracy 90.0% for detection of fibrosis. Conclusion: CK-18 could be used as a non-invasive diagnostic marker in children with CLD.

Vitamin D deficiency is extremely frequent in chronic kidney disease (CKD) and is associated with erythropoietin hypo-responsiveness. Hepcidin, the primary regulator of iron homeostasis, may play a critical role in the response of patients with anemia to iron and erythropoiesis-stimulating agent therapy; however, the participation of hepcidin to anemia in hemodialysis (HD) patients had not been completely characterized. To evaluate the relationship between serum hepcidin, indicators of anemia, iron status, inflammation and 25-hydroxy vitamin D (25-OH D) levels in children with CKD on HD and the impact of vitamin D therapy on these parameters. This analytical case-control, a double-center study was carried out on CKD patients attending the Nephrology Unit of the pediatric department at Benha and El Menofeya University Hospitals. Participants were classified into two groups: Group I Forty patients with end-stage kidney disease (ESKD) on HD. Group II Thirty healthy children of matched age and sex were included as a control group. All participants were subjected to full medical history, thorough clinical examination and laboratory evaluation in the form of complete blood count (CBC), kidney functions, liver functions, IL-6, serum levels of iron, ferritin, hepcidin and 25-OH D levels by ELISA. All patients received ergocalciferol as intensive replacement therapy depending on baseline 25-OH D levels for 3 months followed by maintenance therapy. Pre-treatment levels of study parameters were significantly disturbed compared to control measures. Hepcidin was significantly increased in pediatric HD patients (272.7±152.6 ng/ml) when compared with their respective control subjects (39.1±21.8 ng/ml). A significant positive correlation was demonstrated between serum hepcidin levels and both IL-6 and serum ferritin, while a significant negative correlation was revealed between serum hepcidin and, Hb, serum 25-OH D and iron. Post-treatment with ergocalciferol, the serum ferritin, hepcidin and IL-6 levels were significantly decreased, while Hb level and Hct value were significantly increased compared to pretreatment levels. These findings suggest that hepcidin may mediate the negative effects on both disordered iron metabolism and erythropoiesis in HD patients and that Ergocalciferol could be used therapeutically to reduce hepcidin concentrations and thereby improve erythropoiesis-stimulating agent responsiveness and reduce inflammatory mediators.