الفهرس 
Guidelines for chronic Kidney DiseaseOnly 14 pages are availabe for public view
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Abstract
Chronic kidney disease–mineral and bone disorder (CKD-MBD) is composed of clinical, biochemical and radiological abnormalities associated with CKD, that is manifested by either one or a combination of the following factors: abnormalities of calcium, phosphorus, parathyroid hormone (PTH), or vitamin D metabolism, abnormalities in bone histology, linear growth or strength and vascular or other soft tissue calcification.
Osteoporosis is as a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture.
Bone mineral density (BMD) and bone turnover are the most important factors in the classification of patients with CKD. It has been reported that controlling of biochemical parameters of CKD-MBD (e.g., serum calcium, phosphorus, and PTH levels) is so crucial in these patients.
Dual energy X-ray absorptiometry (DEXA) is the most widely used method to assess bone health. DEXA is inexpensive, fast, readily available and delivers a low radiation dose.
The aim of this study was to assess the Bone mineral density in children with chronic renal failure by using Dual-energy X-ray absorptiometry (DEXA) which is the most widely used method to assess bone health.
This study included 20 children with pediatric onset of chronic Renal Failure (CRF) on HD at the Children’s Dialysis Unit at Pediatric department at Benha University Hospital that were assessed for bone mineral density by using Dual-energy X-ray absorptiometry (DEXA).
Statistical analysis revealed the following:
1. The mean age of study population was 15 years with standard deviation of 3 years, among them, 11 were females (55.0%) and 9 were males (45.0%).
2. Mean onset of the disease was 9 years with standard deviation of 3 years. 35.0% showed family history of CKD. 10.0% showed family history of osteoporosis. Mean height was 130 cm and mean weight was 36 kg. Mean SBP and DBP were 115(mmhg) and 69(mmhg) respectively. 90.0% of patients showed edema, 35.0% showed ascites and 85.0% showed bone-ache.
3. Mean urea & creatinine were 124(mg/dl) and 6.7(mg/dl) respectively. Mean serum ca & PO4 were 7.0(meq/l) and 4.5(mg/dl) respectively. As regard PTH, median was 494.2(pg/ml). Mean ALP was 302(iu/l). Mean Z score of BMD was -3(g/cm2) with standard deviation of 1.5.
4. The mean BMI was 21.14(kg/m2) with standard deviation of 4.85, the mean BMD was 0.498(g/cm2) with standard deviation of 0.185 and the mean BMC was 26.37(g) with standard deviation of 12.88.
5. There was a significant positive correlation between BMD and PTH (r = 0.504 & P value = 0.024), vit.D3 (r = 0.234 & P value = 0.321).And significant positive correlations between BMC and height (r = 0.739 & P value <0.001), weight (r = 0.751 & P value <0.001).
6. No significant correlations between BMD and gender, family history of CKD and Ascites.
It is concluded that a majority of patients with CKD had low level of BMD. In addition, lower levels of Ca, P, PTH were found in patients with abnormal BMD Z-scores and also DEXA may be considered a useful clinical tool for the detection of cortical deficits.
we recommended widespread availability of DEXA, longitudinal studies are needed to determine if DXA is sensitive to changes related to CKD progression and treatments and also Further investigation with the use of bone histomorphometry and pQCT should help to increase understanding the maintenance of normal bone health in children with CRF.