Renal Duplex in Children with Acute Glomerulonephritis: Diagnostic Utility, Laboratory and Pathological Correlation , KAMEL, SARA M., Salah Doaa M., IBRAHIM REHAM M., and Hashem Rania H. , The Medical Journal of Cairo University, Volume 90, Issue 6, p.1833-1843, (2022) mjcu_volume_90_issue_9_pages_1833-1843.pdf
Urinary CXCL 10 is a Monitoring Marker for Acute Rejection in Pediatric Kidney Transplant Recipients, Salah, Doaa M., Bazaraa Hafez M., Bishai Irene E., Sayed Rasha H., Ahmed Mohammed S., Mawla Mohamed Abdel A., and Fadel Fatina I. , European Chemical Bulletin, Volume 12, Issue 4, p.14054-14067, (2023)
Primary Hyperoxaluria type 1 in children: Clinical Classification, Renal Replacement Therapy and Outcome in a Single Centre Experience., Fadel, Fatina I., Kotb Magd A., Abdel Mawla Mohamed A., Hasanin Rasha M., amr mohamed salem, Fathallah Mohamed Gamal, Amr Khalda Sayed, Ahmed Hoda Abdalla, and Salah Doaa M. , Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy, (2022) Abstract

INTRODUCTION: Primary hyperoxaluria type 1 (PH1) is a rare disease that is challenged by the overproduced oxalate and commonly presented with radiopaque renal stones or obstructive uropathy. This study aimed to report clinical presentations, renal replacement therapy (RRT) and outcome of PH1 in end stage kidney disease (ESKD) children.

METHODS: This is an observational cohort study. Data of 22 patients with ESKD due to PH1 were analyzed at Pediatric Nephrology Unit, Faculty of Medicine Cairo University.

RESULTS: Infantile onset patients (n=10) had worst renal outcome (80% with ESRD at presentation, p=0.019) and worse patient outcome (mortality 40%, p=0.016) than juvenile (n=9) and late onset (PH1 n=3) patients. RRT modalities include peritoneal dialysis (PD) in 7 (31.8%), hemodialysis (HD) in 11(50 %) and, combined liver kidney transplantation (CLKT) in 4 (18.2%) patients. Infectious complications were encountered in 42.8% of PD patients. Better HD adequacy was observed with frequent HD (n=6) and/or HD via arteriovenous fistula (AVF) than with infrequent dialysis (n=5) and/or via central venous line (CVL) (P =0.0001 & 0.0047 respectively). Morbidity and mortality (infection related) rates of the whole cohort were 63.6% and 31.8% respectively.

CONCLUSIONS: Clinical presentation of PH1 varies according to the age of onset (infantile onset being the most aggressive form). Aggressive HD (better through AVF) is needed to achieve acceptable HD adequacy, PD was challenged by infection. Infection found to be the main cause of mortality even after successful CLKT. This article is protected by copyright. All rights reserved.

Assessment of volume status of pediatric hemodialysis patients., Fadel, Fatina I., Salah Doaa M., Mawla Mohamed Abdel A., Galal Eman, and Sayed Shaimaa , Pediatric nephrology (Berlin, Germany), (2024) Abstract

BACKGROUND: Accurate volume status assessment and dry weight achievement are the most challenging goals for a nephrologist. We aimed to evaluate the role of ultrasonographic parameters including lung ultrasound and inferior vena cava (IVC) measurements as practical methods of volume status assessment in children on hemodialysis by comparing them with established techniques, such as clinical evaluation and bioimpedance spectroscopy.

METHODS: A prospective cross-sectional study compared pre- and post-dialysis volume status using bioimpedance spectroscopy (BIS) parameters and clinical data with ultrasonographic lung B-lines and IVC parameters in children on regular hemodialysis.

RESULTS: A total 60 children (mean age 9.4 ± 2.8 years) were enrolled. Twenty patients (33.3%) were clinically overloaded to varying degrees (17 patients had mild to moderate signs of fluid overload and 3 patients had moderate to severe signs of fluid overload). All other patients (66.7%) were clinically euvolemic. Sonographic parameters were significantly lower post-dialysis than pre-dialysis, including lung B-line count and IVC diameter. IVC collapsibility index mean was significantly higher post-dialysis than pre-dialysis. There was a significant correlation between the lung B-line count, IVC parameters, and BIS-measured overhydration both before and after hemodialysis. Nine patients had ≥ 8 B-lines post-dialysis, only three of them were hypertensive.

CONCLUSIONS: Clinical criteria alone are not specific for determining accurate fluid status in pediatric hemodialysis patients. Lung B-line score, IVC parameters, and BIS may be complementary to each other and to clinical data. Lung B-lines outperform IVC measurements and BIS in subclinical volume overload detection in pediatric hemodialysis patients.

Vascular access challenges in hemodialysis children., Salah, Doaa M., Fadel Fatina I., Abdel Mawla Mohamed A., Mooty Hesham NAbdel, Ghobashy Mohamed El, Salem Amr M., Fathallah Mohamed Gamal, and Abd Alazem Eman Abobakr , Italian journal of pediatrics, Volume 50, Issue 1, p.11, (2024) Abstract

BACKGROUND: Hemodialysis (HD) success is dependent mainly on vascular access (VA). The aim of this study is to share the experience of Pediatric Nephrology Unit (PNU), Cairo University Children's Hospital (CUCH), with VA-related obstacles in end stage kidney disease (ESKD) HD children.

METHODS: This is a retrospective analysis of VA related data of 187 ESKD children received regular HD over 3 year duration (2019-2021). Kaplan-Meier curves were used to present arteriovenous fistula (AVF) and cuffed catheters survivals.

RESULTS: Uncuffed central venous catheter (CVC) was the primary VA for HD in up to 97.3% with 2.7% of patients had AVF performed and attained maturation before initiation of regular HD. Fifty-six (29.9%) patients have inserted 120 tunneled CVCs. AVFs & AV grafts (AVF) were performed in 79 (42.2%) and 6 (3.2%) patients respectively. There were 112 uncuffed CVCs implanted beneath the screen in Rt internal jugular vein (IJV) (44%) Lt IJV (17%), right internal mammary vein (2.7%) while Trans hepatic (TH) technique was used to place 39 uncuffed CVCs (34%) in the inferior vena cava (IVC). Catheter-related bacteremia (CRB) was the most frequent complication in uncuffed and cuffed CVCs (2.58 / 100 catheters day and 10.1 /1000 catheter days respectively). AVFs achieved a high success rate (83%) after 757.71 ± 512.3 functioning days.

CONCLUSION: Native AVF is the preferred VA for pediatric HD but its creation is limited by the small sized vessels where non-cuffed CVC could be a reasonable relatively long-term alternative. Challenging situations (occluded central veins) could benefit from TH technique of CVC insertion in IVC.

Does Urinary Vitamin D-Binding Protein Have a Role in the Prediction of Steroid Resistance in Nephrotic Syndrome? A Cohort Study on Egyptian Children, Salah, Doaa M., Aoun Ahmed H., Fahmy Balsam Sherif, Zeid Asmaa Hasan Mahaseb Abu, and Fahmy Yosra Aboelnaga , Journal Of Comprehensive Pediatrics, Volume 14, Issue 1, p.e130133, (2023) jcp-130133.pdf
Significance of anti-endothelial cell antibodies in paediatric kidney transplant recipients, Ismail, Mervat, Fadel Fatina I., Rashad Alaa, Salah Doaa M., Rasheed Maha, Kantoush Nagwa, H.Ibrahim Mona, Kafoury Mona R., and Elshamaa Manal F. , Polish Journal of Paediatrics, Volume 98, Issue 1, p.1-7, (2023) pped_art_50197-10.pdf
Impact of kidney transplantation on serum bone mineral levels and anemia – a cohort study on Egyptian children, Hagras, Amal Mostafa, Galal Rasha Essam Eldin, Baz Heba Nabil, Zeid Ahmed, El-Din Samah Shaaban Nour, and Salah Doaa M. , Polish Journal of Paediatrics, Volume 98, Issue 2, p.93-101, (2023) pped_art_50892-10.pdf
Monitoring of blood glucose after pediatric kidney transplantation: a longitudinal cohort study., Salah, Doaa M., Hafez Mona, Fadel Ftaina I., Selem Yasmen Ahmed Said, and Musa Noha , Pediatric nephrology (Berlin, Germany), Volume 38, Issue 3, p.847-858, (2023) Abstract

BACKGROUND: Glucose metabolism after kidney transplantation (KT) is highly dynamic with the first post-transplantation year being the most critical period for new-onset diabetes after transplantation (NODAT) occurrence. The present study aimed to analyze dynamics of glucose metabolism and report incidence/risk factors of abnormal glycemic state during the first year after KT in children.

METHODS: Twenty-one consecutive freshly transplanted pediatric kidney transplant recipients (KTRs) were assessed for fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) weekly for 4 weeks, then every 3 months for 1 year.

RESULTS: Interpretation of OGTT test showed normal glucose tolerance (NGT) in 6 patients (28.6%) while 15 (71.4%) experienced impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) at any time point of monitoring. Seven patients had NODAT, for which three needed insulin therapy. Hyperglycemia onset was 7.8 ± 13.12 weeks (median (range) = 1 (0-24) week) after KT. Percent of patients with abnormal OGTT was significantly more than that of IFG (38.1% vs. 71.4%, p = 0.029). Patients with abnormal glycemic state had significantly elevated trough tacrolimus levels at 6 months (p = 0.03). Glucose readings did not correlate with steroid doses nor rejection episodes while positively correlating with tacrolimus doses at 3 months (p = 0.02, CC = 0.73) and 6 months (p = 0.01, CC = 0.63), and negatively correlating with simultaneous GFR at 9 months (p = 0.04, CC =  - 0.57).

CONCLUSIONS: Up to two thirds of pediatric KTRs (71.4%) experienced abnormal glycemic state at some point with peak incidence within the first week up to 6 months after KT. OGTT was a better tool for monitoring of glucose metabolism than FPG. Abnormal glycemic state was induced by tacrolimus and adversely affected graft function. A higher resolution version of the Graphical abstract is available as Supplementary information.

Multidrug resistant 1 (MDR1) C3435T and G2677T gene polymorphism: impact on the risk of acute rejection in pediatric kidney transplant recipients., Korkor, Mai S., El-Desoky Tarek, Mosaad Youssef M., Salah Doaa M., and Hammad Ayman , Italian journal of pediatrics, Volume 49, Issue 1, p.57, (2023) Abstract

BACKGROUND: Tacrolimus is the backbone drug in kidney transplantation. Single nucleotide polymorphism of Multidrug resistant 1 gene can affect tacrolimus metabolism consequently it can affect tacrolimus trough level and incidence of acute rejection. The aim of this study is to investigate the impact of Multidrug resistant 1 gene, C3435T and G2677T Single nucleotide polymorphisms on tacrolimus pharmacokinetics and on the risk of acute rejection in pediatric kidney transplant recipients.

METHODS: Typing of Multidrug resistant 1 gene, C3435T and G2677T gene polymorphism was done using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) for 83 pediatric kidney transplant recipients and 80 matched healthy controls.

RESULTS: In Multidrug resistant 1 gene (C3435T), CC, CT genotypes and C allele were significantly associated with risk of acute rejection when compared to none acute rejection group (P = 0.008, 0.001 and 0.01 respectively). The required tacrolimus doses to achieve trough level were significantly higher among CC than CT than TT genotypes through the 1st 6 months after kidney transplantation. While, in Multidrug resistant 1 gene (G2677T), GT, TT genotypes and T allele were associated with acute rejection when compared to none acute rejection (P = 0.023, 0.033 and 0.028 respectively). The required tacrolimus doses to achieve trough level were significantly higher among TT than GT than GG genotypes through the 1st 6 months after kidney transplantation.

CONCLUSION: The C allele, CC and CT genotypes of Multidrug resistant 1 gene (C3435T) and the T allele, GT and TT genotypes of Multidrug resistant 1 gene (G2677T) gene polymorphism may be risk factors for acute rejection and this can be attributed to their effect on tacrolimus pharmacokinetics. Tacrolimus therapy may be tailored according to the recipient genotype for better outcome.