الفهرس 
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Abstract
Hearing deterioration is increasingly recognized as an important complication of nephrotic syndrome in patients with prolonged clinical courses. Risk factors include the presence of hypocalcemia, hypertension, hyperlipidemia and long-term treatment with steroid and other immunosuppressive drugs. The current study was done to evaluate the hearing status in children with nephrotic syndrome and to detect of the risk factors associated with hearing impairment. The children in this study were classified into 4 groups: • group 1: Included thirty children with infrequent relapser and steroid sensitive nephrotic syndrome. • group 2:Included thirty children with frequent relapser and steroid dependent nephrotic syndrome . • group 3:Included thirty children with steroid resistant nephrotic syndrome. • group 4: Included ninety apparently healthy children with matched age and sex. All children underwent through history taking, physical examination and laboratory investigation in the form of serum cholesterol, creatinine, BUN, albumin level, serum calcium and urine protein to urine creatinine ratio
Audiological assessment:
a. Two channel pure tone audiometer, (model Madsen Orbiter 922): For
detection of hearing levels at different frequencies in a sound treated
room.
b. Tympanometry GSI (GrasonStadler instrument): For detection of
variable measures as compliance, resonant frequency and pressure
gradient.
The results of current study demonstrated:
A significant statistical difference was observed between patient and
control groups regarding systolic and diastolic BP, serum albumin level, serum
cholesterol level, serum creatinine, BUN, protein in urine and serum calcium
level. No statistical difference was observed between patient and control groups
regarding demographic data or anthropometric measurements.
In comparison between the studied groups regarding pure tone
audiometry results. We found significant statistical difference in hearing
threshold between the patients and controls. The affection was mainly at 250,
500 and 1000 frequencies. Out of all children in withIRNS/SSNS, six (20 %)
had mild sensorineural hearing impairment. In SDNS/FRNS category, eight
(27%) had mild sensorineural hearing impairment, while fourteen (46.8 %) had
mild sensorineural hearing impairment in SRNS category. This showed
increased incidence of sensorineural hearing impairment in SRNS category in
comparison with other categories which may be related to long course of the
disease and the use of immunosuppressant drugs.
Patients with SRNS category were observed to have lower serum albumin
and calcium level, with higher levels of protein in urine, serum cholesterol,
systolic and diastolic BP, creatinine, BUN and urine prt/crt ratio.
According to our observations, a positive correlation was found between
systolic and diastolic BP and audiometry results at frequencies 250, 500 and
1000 Hz, and negative correlation between serum calcium and audiometry
results at frequencies 250, 500 and 1000Hz in patients affected with
sensorineural hearing impairment
This study concluded that:
1. The hearing was affected in 30% of children with NS more in SRNS.
2. We could not clarify the main etiology; further larger studies are needed
to understand the etiology, clinical implications, long term prognosis of
this abnormality and how to manage.
3. The major risk factors for hearing impairment were high serum levels of
cholesterol, low serum levels of calcium, low serum levels of albumin
and higher levels of blood pressure.
The authors recommend that:
1. Pure tone audiometry testing should be done to nephrotic children for
early diagnosis and management of hearing loss.
2. Further researches are needed to evaluate the hearing status in different
stages of nephrotic syndrome.
3. Further longitudinal studies during relapse and remission are required, to
evaluate the etiology and to investigate the influence, clinical
implications of deterioration of hearing status on children with nephrotic
syndrome during and after the course of the disease, and long term
prognosis of this abnormality.
4. Prevention of risk factors for hearing impairment such as high serum
levels of cholesterol, low serum levels of calcium, low serum levels of
albumin and higher levels of blood pressure.