الفهرس 
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Abstract
Chronic kidney disease is characterized by an irreversible deterioration of renal function that gradually progresses to end-stage renal disease. During the past 2 decades, the incidence of CKD in children has steadily increased. CKD is asymptomatic in its earliest stages (stage I and stage II), although urinalysis findings or blood pressure may be abnormal. As CKD progresses to more advanced stages, signs and symptoms greatly increase.
End-stage renal disease is defined as a disease characterized by kidney failure that requires any form of chronic dialysis or kidney transplantation. Common causes of pediatric ESRD are other diseases, such as primary glomerulonephritis. Cystic/hereditary/congenital diseases such as renal hypoplasia, dysplasia, and congenital obstructive uropathy are the next most common cause.
Helicobacter pylori infection affects more than half of the world population and it occurs generally in childhood. It is associated with gastroduodenal ulcer, gastric atrophy, intestinal metaplasia and lymphoid tissue-associated lymphoma. It is difficult to eradicate this bacterium due to its high antimicrobial resistance. In children, the infection is asymptomatic in the majority of cases and complications are less common.
The chronic kidney disease and end-stage renal disease cause many organ complications including GIT, affect whole GIT parts leading to multiple different lesions. GIT lesions in those patients lead occasionally to serious different clinical symptoms. In CKD patients, immunity is usually suppressed. This impairment of immune system function in CKD patients has led to investigator to postulate that H. pylori has a significant role in increasing risks for both gastritis and peptic ulcer
A cross-sectional study was conducted in dialysis unit of pediatric department in Menoufia university hospital included 62 pediatric patients with ESRD undergoing regular hemodialysis.
The aim of the work
The aim of the present study was to determine the incidence of H. Pylori infection in pediatric patients with chronic kidney disease on regular hemodialysis and investigate the diagnostic value of non-invasive tests (Urea Breath Test, stool antigen test and serology) in diagnosing H. pylori infection in hemodialysis patients.
A written informed consent was obtained from all parents of subjects and was approved by local ethics committee of Menoufia University.
The target population were subjected to detailed history, medical history, drugs intake history, clinical examination, anthropometric measures and laboratory investigations (CBC, urea level before and after dialysis, serum creatinine before and after dialysis, serum ferritin, H. Pylori SAT, serum H. Pylori Antibodies and UBT).
Our results revealed that:
In the current study, age of patients ranged between 6-18 years. The patients’ mean age was 12.8 years, 56.5% were males, positive consanguinity presented in 22.6%, positive family history presented in 12.9%. Weight of the studied group ranged between 15 – 49.5 Kg, length ranged between 1-1.7 m and BMI of the studied group ranged between 8.14 – 32.3 Kg/m2. CKD duration ranged between 0.5 – 12 years and hemodialysis duration ranged between 1 – 11 years.
Summary
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No significant relation between H. pylori infection and age, sex consanguinity and family history among the studied patients.
The mean CKD duration among studied cases was 5.34 years and the mean hemodialysis duration was 3.61 years. There was significant relation between disease duration and hemodialysis duration with the presence of H. pylori infection, there were significantly higher among positive cases.
Glomerulonephritis was the most common cause of the disease among the studied patients (40.3%), followed by obstructive uropathy (22.5%).
Regarding abdominal manifestations; all patients complained from nausea, 71% vomiting, 67.7% had abdominal pain and 85.5% had heartburn. None complain of diarrhea, hematemesis and melena.
Regarding history of drug intake, 64.5% of patients had history of antacids intake, 16.1% steroid intake, 1.6% NSAID dugs and 14.5% immunosuppressive. There was no significant relation between H. pylori infection and drug intake history of among the studied patients except for intake of antacids 96.6% of patients with H. pylori infection take antacids (P value= 0.001).
Laboratory measurements showed that mean hemoglobin level of the studied group was 10.6, mean platelet count was 208.3, mean RBCs count was 4.29, mean WBC count was 7.12, mean urea level before dialysis was 109.3 and after dialysis was 46.4. Mean creatinine level before dialysis was 6.82 and after dialysis was 3.08. Mean ferritin level was 759.5 ng/ml. There was no significant relation between H. pylori infection and laboratory investigations among the studied patients.
Positive culture present in 25.8% (16 cases). The most common organism was shigella 81.3%.
The prevalence of Helicobacter was 46.8% among the studied patients. There was no significant relation between H. pylori infection and clinical data of the studied patients.
There was no significant relation between H. pylori infection and age, sex, weight, length, BMI, consanguinity and family history among the studied patients. There was significant relation between disease duration and presence of infection it was significantly higher among positive cases 6.53 vs 4.30 (P value=0.004). There was significant relation between duration of hemodialysis and presence of infection it was significantly higher among positive cases 5.37 vs 2.06 (P value=0.001). No significant relation between H. pylori infection and etiology of the disease among the studied patients (P >0.05).
Sensitivity, specificity, positive and negative predictive values and accuracy for both serology and SAT in diagnosing of H. pylori in hemodialysis patients were (100%, 97%, 97% 100% and 98%); while, UBT was (66%, 67%, 63%, 69% and 66%) respectively.