الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Chronic kidney disease (CKD) is a clinical syndrome characterized by a gradual loss of kidney function over time. The Kidney Disease Improving Global Outcomes (KDIGO) guidelines have defined CKD as abnormalities of kidney structure or function, lasting for more than 3 months, with implications to health. Children with CKD usually present with disease impact on growth as well as a cardiovascular complication that not only influences the health of the patient during childhood but also having an impact on the life of the adult that this child will become .Kidney fibrosis refers to the deposition of the pathological matrix in the interstitial space, in the walls of glomerular capillaries, and around arterioles secondary to immunological, mechanical, metabolic, and toxic insults. Renal scarring results in a progressive loss of renal function and end-stage renal failure that requires life-long dialysis or kidney transplantation. Histologically end-stage kidney disease manifests itself as fibrotic lesions affecting each compartment; glomerulosclerosis, vascular sclerosis and tubulointerstitial fibrosis that can predict and contributes to functional the demise of the kidney. Aim of work: demonstrate the role of diffusion tensor imaging (DTI) in the diagnosis of chronic kidney disease (CKD) in pediatric patients, using fraction anisotropy (FA) and apparent diffusion coefficient (ADC) to differentiate between sclerotic and non-sclerotic parenchymatous renal disease and to correlate the FA and ADC of the renal parenchyma with serum biomarkers.Using renal histopathology as a reference standard. Study Subjects: Prospective study was conducted upon 35 pediatric CKD patients (19 boys, 16 girls; mean age 12.2±2.7 years) and 19 age and sex-matched volunteers. Patients with sclerotic (n = 25) and non-sclerotic (n= 10) parenchymatous kidney disease. Patients and volunteers underwent DTI of the kidney. The FA and ADC of the renal cortex and medulla were calculated from 3 regions of interest (ROI) of both kidneys Inclusion criteria All children aged more than 2 years of age and fulfilling the criteria for diagnosis of CKD will be considered eligible for involvement. Exclusion criteria: • Children with chronic kidney disease who did not perform renal biopsies. • Children aged less than 2 years of age. All participants were subjected to: 1- The demographic data (name, age, sex, cause of admission) of each studied child will be taken. 2- History taking,general examination will be carried on for every studied child. 3- Serum and urinary biomarkers 4- Renal biopsy. 5- The correlation coefficient will be calculated to study the relationship between (ADC) value of renal parenchyma, 6- Diffusion tensor imaging Result Pts Vs controls FA of both regions< Mean FA value of the renal cortex and medulla of CKD patients (0.20±0.07, 0.18±0.08) was significantly lower (p=0.001) than that of the volunteers (0.2783±0.080, 0.315±0.09). The the cut-off value of FA of the cortex and medulla to differentiate CKD patients from volunteers ware 0.23, 0.22, AUC were 0.828, 0.848 and accuracy was 82.9%,80.7% ADC both regions: Mean ADC value of the renal cortex and medulla of CKD patients (1.98±0.23, 2.03±0.23) was significantly higher (p=0.001) than that of the volunteers (1.65±0.134, 1.68±0.16). The cutoff value of ADC of the cortex and medulla to differentiated CKD patients from volunteers was 1.75, 1.85, AUC were 0.910, 0.81and accuracy was 84.1%, 79.5% (Fig 3). Pathological sclerosis versus non-sclerotic: The renal FA of renal cortex and medulla in pathologically proven sclerotic parenchymatous renal disease (0.17±0.05, 0.16±0.06) was statistically lower (p= 0.001 respectively) than that of non-sclerotic renal disease (0.26±0.06, 0.24±0.08). The renal ADC of the renal medulla in pathologically proven sclerotic parenchymatous renal disease (2.04±0.22X10-3mm2/s) was higher (p=0.362) than that of non-sclerotic renal disease (and 1.99±0.25 X10-3mm2/s) (table1). Correlation (serum creatinine and e GFR) The FA of the renal cortex and medulla in patients with CKD correlated with serum creatinine (r= -.468, P=.000, r=-.381, p=.001 respectively) and e GFR (r= .364, P=.002, r=.318, p=.007 respectively). The ADC of the renal cortex and medulla in patients with CKD correlated with serum creatinine (r=.157, p =.193,r=-.115,p=.342 respectively) and e GFR (r=-.157,p=.193 r=.097,p=.425 respectively) (table 2). Conclusion We concluded that FA and ADC of the renal cortex/medulla may help in the differentiation of CKD from volunteers, differentiation of sclerotic from non-sclerotic CKD. FA and ADC could also correlate with eGFR and CKD staging Limitation This study has limitations. First, this study included a small number of patients that limits the statistical analysis. Second, the FA and ADC were calculated from a single seed region of interest of the renal cortex.