Background: Indoxyl sulfate (IS) is a non-dialyzable gut-derived uremic toxin that is reported to be cardiotoxic in patients with advanced chronic kidney disease stages.Aim of the Work: The aim of this study was to investigate the role of IS as a risk factor for cardiovascular complications in children with end stage kidney disease (ESKD) on regular HD.Patients and Methods: This is a cross-sectional analytical study that included children with ESKD on regular hemodialysis (HD) for at least 6 months following at Nephrology Unit of Cairo University Pediatric Hospitals. Serum IS level was measured for all patients by the enzyme-linked immunosorbent assay (ELISA). Cardiac complications was assessed using the M mode and 2D transthoracic echocardiography.Results: The study comprised 88 children with ESKD on regular HD for a mean ± SD of 31.94 ± 26.05 months, with a mean age ± SD of 9 ± 3.2 years (range 3.3- 14 years). Of them 52 (59.1%) were males. Obstructive uropathy (28.4%), and focal segmental glomerulosclerosis (20.5%), were the main causes of ESKD in the study group. Cardiovascular complications were identified in 48 (54.5%) patients in the form of dilated cardiomyopathy in 44 (50%) children with decreased fractional shortening <30% and moderate to severe left ventricular hypertrophy above 95th for age and gender in 10 (11.4%). Cardiovascular affection correlated with duration of HD, hypertension, and IS serum level (p=<0.001 for each). Hypertension was reported in 55 (62.5%) of patients, and vascular access related complications were evident in 40 (45.4%) patients with thrombosis being the commonest complication in 16 (18.1%). The mean IS was 29.14 ± 17.43 μg/ml in ESKD patients with normal cardiac function, and 77 ± 15.18 μg/ml among those with cardiac compromise (p < 0.001). The IS level correlated with longer duration of HD (p= 0.002), and older age (p= 0.043). IS level and duration of HD did not predict cardiomyopathy, (p=0.192), and (p=0.760) respectively.Conclusion: Cardiac complications are common among children on HD. Both cardiovascular complications and IS accumulation correlated positively with longer duration of HD, and age of children with ESKD. IS is non-dialysable and there is a need to control its production from the gut.

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. 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. 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 and 0.0047, respectively). Morbidity and mortality (infection related) rates of the whole cohort were 63.6% and 31.8%, respectively. 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.

Cognitive radio sensor networks (CRSNs) have been proposed to serve as a reliable, robust, and ef- ficient communications infrastructure that can address both the existing and future energy manage- ment requirements of the smart grid. The existing and envisioned applications of CRSN-based smart grid include substation automation, overhead transmission line monitoring, home energy management, ad- vanced metering infrastructure, wide-area situational awareness, demand response, outage management, distribution automation, asset management. To realize these applications, in this paper, honey bee mating optimization-based routing and cooperative channel assignment algorithms have been proposed. The de- veloped framework significantly decreases the probability of packet loss and preserves high link quality among sensor nodes in harsh smart grid spectrum environments. The proposed approach performance has been evaluated in terms of packet delivery ratio, delay, and energy consumption demonstrating that it has successfully addressed the QoS requirements of most of the SG applications presented.

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BACKGROUND: An essential milestone in pediatric transplantation is to find noninvasive biomarkers to monitor acute rejection (AR). In this retrospective (Case-control) study, we examined the role of Fas -670A/G and Fas Ligand (FasL) -843C/T gene polymorphisms in allograft nephropathy in pediatric renal transplant recipients.

METHODS: In 47 pediatric kidney transplant recipients and 20 healthy controls, Fas -670A/G and FasL -843C/T gene polymorphisms as well as serum soluble Fas Ligand level (sFasL) were measured.

RESULTS: Serum sFasL levels were significantly higher in transplant recipients children than that in controls (548.25±298.64pg/ml vs 143.17±44.55pg/ml, p=0.0001). There was no significant difference between patients with AR and those without AR in regards to serum sFasL levels (567.70±279.87pg/ml vs 507.85±342.80pg/ml, p=0.56). Fas -670A/G genotypes or alleles were not significantly different between controls and transplant recipients and among transplant recipients with and without AR. (P>0.05 for all). FasL -843C/T genotypes were not different between transplant recipients and controls and among transplant recipients with and without AR (P>0.05 for all). However, Frequency of C allele in transplant patients was significantly higher than that in the control group (44.68% vs 25%, P=0.03). FasL -843C/T alleles were significantly different between patients with and without AR (P=0.03). The percentages of C allele were higher in children with AR (58.82% vs 36.67%). We found that serum FasL and serum creatinine were variables that were independently associated with AR.

CONCLUSION: This study suggests that FasL gene polymorphisms in peripheral blood might be accurate in detecting cellular AR.