Pediatric kidney transplantation is a multidisciplinary therapy that needs special consideration and experience. In this study, we aimed to present CUCH experience; over a 10‐year period, as a specialized center of kidney transplantation in children. We studied 148 transplantations performed at a single center from 2009 to 2018. Pretransplant and follow‐up data were collected and graft/patient survival rates were evaluated. A total of 48 patients developed at least one rejection episode during 688 patient‐years of follow‐up. Infections, recurrence of original disease, and malignancy were the most important encountered medical complications (20%, 2%, and 1.4%, respectively). One‐year patient survival was 94.1%, while graft and patient survival was 91.9%. Graft/patient survival at 5, 7, and 9 years was 90%, 77%, and 58%, respectively. Infections were the main cause (69%) of mortality. Death with a functioning graft and CR were the main causes of graft loss (48% and 33%, respectively). Pediatric kidney transplantation in Egypt is still a challenging yet successful experience. Rejections and infections are the most frequent complications. Short‐term outcomes surpass long‐term ones and graft survival rates are similar to the international standard.

Background: Acute kidney injury (AKI) poses a significant burden for the society, in terms of health resource use during the acute phase, and the potential long-term sequelae including development of chronic kidney disease and kidney failure. Aim of the work: to investigate the risk of development of AKI in critically ill children. Material and methods:A cohort study conducted on 60 critically ill children admitted at pediatric intensive care unit (PICU). They were divided into two groups according to hemodynamic stability. Cardiovascular parameters together with criteria for AKI were observed during the first 5 days of PICU admission. AKI was diagnosed based on Acute Kidney Injury Network criteria. Results: From all critically ill included patients (60 patients); thirty four patients developed AKI (56.6%). Frequency of AKI was significantly more in hemodynamically unstable than stable patients 22 (73%) versus 12 (40%) (p=0.018). AKI was strongly associated with decreased baseline systolic and diastolic blood pressure percentiles (p=0.04) and (p=0.049), increased doses and duration of inotropic support determined by vasoactive inotropic score (p=0.002) and (p=0.013) respectively, higher base deficit in baseline blood gases (p=0.002), multiple organ dysfunctions (p<0.001) and exposure to nephrotoxic agents (p=0.036). Conclusion: AKI is a common morbidity among hemodynamically unstable critically ill children. AKI is strongly associated with initial hypotension on admission, increased doses and longer duration of inotropic support, increased base deficit in initial blood gases evaluation, multiple organ dysfunctions and exposure to nephrotoxic agents.

BackgroundPain is a significant problem in more than 50% of hemodialysis patients and is not being effectively managed1. In patients on regular dialysis, musculoskeletal pain was identified as the most disturbing pain and the majority reported that pain limited their daily life activities2ObjectivesThe aim of the study is to detect and describe the incidence of musculoskeletal manifestations, comorbidities and gender differences in renal failure patients on regular hemodialysisMethodsForty-nine patients with renal failure and on regular dialysis were included in the present study. The patients were subjected to full history taking and clinical examination. Blood samples were collected before the mid-week session for laboratory investigations. The bone mineral density (BMD) was assessed by dual energy X-ray absorptiometry (DXA) in all patients. Kt/V was used as a marker of dialysis adequacyResultsThe 49 patients mean age was 54.41±15.9 years. They were 28 males and 21 females. The dialysis duration was 3±2.31 years. Comorbidities were present as diabetes (45%), hypertension (96%), cardiovascular (33%), cerebrovascular stroke (6%), hyperuricemia (37%), hepatitis C (16%) and amyloidosis (8%). The following musculoskeletal findings were present in descending frequency: fibromyalgia syndrome (51%), myalgias (37%), arthralgia (37%), flexor tenosynovitis (29%), cramps (29%), ectopic calcifications (25%), flexion deformity of the elbow (16%), carpal tunnel syndrome (14%), and destructive spondyloarthritis (8%). Vasculitis was present in 2. Positive anti-CCP was present in 1 female and rheumatoid factor in 4 females and 1 male. Otherwise, there was a tendency to a higher frequency of musculoskeletal findings in males. Vitamin D insufficiency (25.1±14.6ng/ml) and reduced bone mineral density were present. The DXA t-score at lumbosacral spine was -1.51±1.77, hip (-1.65±1.59) and forearm (-1.89±1.9).ConclusionsMusculoskeletal manifestations and comorbidities are frequent and overlooked in hemodialysis patients especially males and the associated chronic pain may affect their quality of life.ReferencesDavison SN. Pain in hemodialysis patients: prevalence, cause, severity, and management. Am J Kidney Dis. 2003;42(6):1239–47.Gamondi C, Galli N, Schönholzer C, Marone C, Zwahlen H, Gabutti L, et al. Frequency and severity of pain and symptom distress among patients with chronic kidney disease receiving dialysis. Swiss Med Wkly. 2013;143:w13750Disclosure of InterestNone declared

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Background Familial Mediterranean fever (FMF) is an autoinflammatory disease that can have conduction disturbances and cardiac rhythm disorders as manifestations of cardiac involvement. The aim of the study is to assess the susceptibility of children with FMF to cardiac repolarization abnormalities and therefore arrhythmia in children with FMF. Methods A cross sectional study conducted on 60 children had FMF and 40 age and sex matched healthy controls. Cardiac repolarization markers, cardiac dimensions and functions were assessed by electrocardiogram (ECG) and conventional echocardiography in patients and controls. Results The mean ± SD age of the patients was 10.43 ± 3.472 years, corrected QT (QTc) and the ratio of peak to end T wave (Tpe) over QTc interval (Tpe /QTc) increased significantly in FMF patients more than healthy control (p value 0.023 and 0.022 respectively). P wave dispersion (Pd) was significantly higher in FMF patients with amyloidosis (p value 0.030). No significant difference was found in cardiac dimensions and functions between the two groups. We found a statistically negative correlation between Pd and age of patients at time of study, age of disease onset and age at diagnosis. On the other hand, we found a statistically significant positive correlation between Pd with number of attacks per year and disease severity score. Furthermore, Tpe/QTc ratio correlated with FMF 50 score, QTc correlated with 24 hours proteinuria. QT, JT intervals correlated with fibrinogen. Conclusions FMF Patients may have increased risk of arrhythmia and should be monitored on regular basis. Compliance to colchicine therapy and better disease control might play a role in decreasing this risk.