الفهرس 
? INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 144 |  |  |
| | | from | 144 | | |
Abstract
Chronic kidney diseases can be defined as either renal injury (proteinuria) and or glomerular filtration rate <60 ML/1.73 M2 for more than 3 months(Andrewet al., 2005).
Pathogenesis of chronic kidney disease include adaptive–hyperfilteration injury, proteinuria and other factors which may be considered to occur secondary to renal affection however lead to progression of CKD like anemia,hypertension and metabolic acidosis(Eddy andNelson, 2006).
In ESRD clinical picture include diverse manifestation like vomiting,anemia, hyperkalemia, metabolicacidosis, growth retardation, renal osteodystrophy, poor appetite, gastrointestinal upsets,hypertention, myocardial dysfunction and endocrine disturbances(Andrew et al., 2005).
Among theseEndocrine disturbances;alterations on sex steroid production and metabolism (leading to primary hypogonadism and disturbances of the hypothalamic-pituitary axis) these are already seen when moderate reductions in the GFR arise(Yilmazet al.,2011). These disorders are not normalized with initiation of maintenance dialysis treatment; instead they often progress. Humoral factorswhich accumulate in uremiaas well as other comorbid conditions that frequently accompany CKD and medications may contribute to suppressed sex hormone levels(Iglesias et al., 2012).
Male hypogonadismleads to impaired reproductive health in adult due to abnormal spermatogenesis, steroidogenesis, sexual dysfunctionand delayed growth& puberty in children (Iglesias et al., 2012).
Pubertal assessment in children with chronic kidney disease is based on Tannerscale of puberty which is divided in to five stages depending on testicular size, penis size,pubic hairand other secondary changes.
This comparative cross sectional study comprised nineteen(19)male children with CRF on regular hemodialysis aged 6-17 year(case group) and ten(10)healthy children age and sex matched(control group).
The aim of this study is todetermine the effect of chronic renal failureon testosterone hormone level in male children and to evaluate the pattern of pubertal growth in these patients.
All patients were subjected to complete history taking ,full clinical examination including anthropometric measure assessment,Tanner scale of puberty andlaboratory studies includingSerum total testosterone hormone,gonadotropins(LH & FSH), CBC, kidney function test(blood urea nitrogen& serum creatinine), iron, electrolytes, albumin andCRP.
The obtained results were statistically assessed using SPSS; Comparison of the two groups was done, the results showingthat there is significant difference between two groups in testosterone and gonadotropin levels.
Eight cases (42.1%)have low testosterone level and eleven cases (57.9%) have normal testosterone hormone level according to normal reference range of testosterone hormone relative to age in male.
Case group are further subdivided into two subgroups:
Subgroup1 (cases with normal hormone level N= 11).
Subgroup2 (cases with low hormone level N =8).
Comparison wasmade between two subgroups as regard clinical and laboratory data.ANOVA test was chosen to assess the most important factorsthat lead to testosterone deficiency in patients with CRF.It revealed that in patients with CRF; higher phosphorus level, higher CRP, higher creatinine level andreceivinganti-hypertensive drugswere the main riskfactors that cause low testosterone hormone level. Consequentlythis affect genital maturation and causes delayed puberty in these patients.Other factors like age, duration of dialysis, blood urea and electrolytes don’t play arole in hypogonadism. Also Tanner scale in patients with CRF was significantly differ than in control group.