الفهرس 
AbstractOnly 14 pages are availabe for public view
 |  | from | 130 |  |  |
| | | from | 130 | | |
Abstract
Bacterial infections are a major cause of mortality in patients with chronic kidney disease as these patients are often clinically compromised .Therefore, it is important to diagnose bacterial infection at an early stage to improve prognosis.
The early initiation of antibiotic therapy has a major impact on the clinical outcome of these patients.
There is a dramatic increase in antibiotic resistance which emerged without the prospect of development of novel classes of antimicrobial agents. Therefore, reduction of the unnecessary use of antibiotics is mandatory.
Procalcitonin (PCT), with molecular mass of 14.5 KDa, is the 116 amino acid polypeptide precursor of calcitonin, a calcium regulatory hormone. Production is governed by Calc-1 gene, located on chromosome 11.Calc-1 codes for preprocalcitonin which undergoes proteolytic cleavage of its signal sequence to produce PCT.
Serum Procalcitonin (PCT) levels are of interest as a biomarker in patients with bacterial infections for several reasons. Serum PCT levels are elevated in patients with bacterial pneumonia, UTI and septic shock. Therefore, serum PCT levels potentially can assist in clinical decisions regarding whether patients with chronic kidney disease with bacterial infection would benefit from empirical antibiotic therapy.
This study was designed to evaluate serum level of procalcitonin in cases of chronic kidney disease patients with bacterial infections. The present study was conducted on 60 chronic kidney disease patients and have bacterial infections diagnosed clinically as lower respiratory tract infections (pneumonia) or UTI, enterocolitis, and supported by radiological, laboratory investigations. The patients were recruited from Beni-Suef university hospital department of pediatrics. They were divided into 2 groups, group (I) include 30 patients of chronic kidney disease with bacterial infections and the second group (control) include chronic kidney disease patients on apparently health (without infections), children matched for age ,sex and socioeconomic status.
All patients and controls included in the study were subjected to the following:
1) Full clinical evaluation including:
• Detailed history taking stressing on presence or absence of fever, cough, shortness of breath, crepitation and grunting, changing color of urine, frequency, dysuria.
• Thorough physical examination lying stress on temperature, respiratory rate as part of general examination. Chest and abdominal examinations as part of local examination.
2) Laboratory investigations :
• Complete blood count (CBC) by differential scanning calorimeter, C- reactive protein (CRP) by Abbott Aeroset method.
• For patients and control: serum PCT level by ELISA
3) Radiological investigation:
• Chest X -ray for patients with chest infection only.
4) Microbiological investigation:
• Urine culture for urinary tract infection cases only.
• Regarding age, Gender, consanguinity and socioeconomic status there were no significant difference between studied groups.
As regard clinical data there is high significant difference between group I and group II regarding, tachypnea and crepitation being higher in group I. There were significant difference between the two groups as regards dysuria, urgency, frequency and changing color of urine being higher in group I than group II.
As for vital signs data they were significantly different between studied groups.
Regarding WBCs & granulocytes were slightly higher in group I than in group II.
As regard CRP it was higher in group I than group II.
Regarding serum level of PCT, our study revealed that it was significantly higher in group I than group II (control).
Our results concluded that PCT is a reliable marker for diagnosis of bacterial infections in chronic kidney disease patients.