الفهرس 
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Abstract
Aluminium (Al) is an ingredient of a variety of foodstuffs and medication as well as of domestic water supplies. Hemodialysis patients and chronic kidney disease (CKD) stage 3-4 are more susceptible to Al toxicity due to little or no ability of kidney to excrete aluminium. The various syndromes of aluminium toxicity were identified in those patients especially whom treated with dialysis, including Al encephalopathy, non-iron deficiency microcytic anemia and Al related bone disease.
Aim of the work: To measure serum level of aluminium in renal failure patients on regular hemodialysis and CKD3,4 and compared their levels after deferoxamine (DFO) infusion. Evaluation of usefulness of DFO as a chelator for decreasing total body aluminium burden in dialysed patients and analyze the correlation between their levels and clinical manifestation and laboratory parameters.
Patients and methods: This study was carried out on 62 patients (38 of them were patients of end stage renal failure on regular hemodialysis(group1), 24 patients with renal insufficiency (CKD stage 3 and 4)(group2) and fifteen healthy age and sex matched children as a control were enrolled in this study. Assessment of serum aluminium level by atomic absorption spectophotometry, three times in Hemodialysis group (HD), before and after DFO by 5 hours and after dialysis. Twice in CKD 3-4 group before and after DFO by 48 hours. Once in control group. All patients were subjected to complete blood picture, serum albumin, total plasma protein, blood urea nitrogen, creatinine, calcium and phosphorous, iron, ferritin intact level of parathyroid (iPTH). Dexa scans, nerve conduction velocity, electeromyelography (EMG) were done for HD group. Al was measured in dialysate, water system unit for dialysis and samples from patient’s homes.
Results: Our case-control study demonstrates that there is a highly significant increase in serum aluminium level after DFO followed by a highly significant decrease in serum Al level after dialysis in HD group.A highly significant increase in Al level after DFO in oliguric and anuric patients than polyuric patients of HD group. A highly significant increase in mean corpuscular volume (MCV) after Al chelation by DFO for 6 months. A highly significant decrease of Al after 3 successive days of DFO and dialysis in HD group with neurological manifestation .Conclusion: Serum aluminium level test are unreliable without challenge test with DFO. DFO liberates Al from tissues by chelating, aluminoxamine complex removed either by dialysis by high-flux membrane or residual kidney function. Dialysate is a main source of Al in HD patients.
Key words: Aluminium, Renal failure, Children.