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ORIGINAL ARTICLE
Year : 2020  |  Volume : 33  |  Issue : 1  |  Page : 173-178

Evaluation of serum resistin in children with chronic renal failure


1 Department of Pediatric, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Clinical Pathology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Department of Pediatric, El Shohada Central Hospital, Menoufia, Egypt

Date of Submission07-Oct-2018
Date of Decision25-Dec-2018
Date of Acceptance30-Dec-2018
Date of Web Publication25-Mar-2020

Correspondence Address:
Sekina Z. M Elsawy Derbala
El Shohada, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_310_18

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  Abstract 


Objective
To evaluate the serum level of resistin in kids with persistent renal failure and correlation with other medical and laboratory parameters.
Background
Serum resistin is elevated in chronic renal failure due to a reduced renal clearance and there may be an inverse correlation between resistin and renal characteristic.
Patients and methods
This study was carried out as a case–control study and included 96 children aged from 6 to 18 years (34 undergoing hemodialysis and 30 on conservative remedy) and 32 apparently healthy kids who constituted the control group, who were recruited from the pediatric hemodialysis unit of Menoufia University Health Facility, Egypt, from May 2017 to April 2018. Complete blood count and electrolytes have been measured before hemodialysis; however, serum resistin was measured before and after hemodialysis in kids with persistent renal failure.
Results
A highly significant increase in resistin level in the case groups and the control group. This highly significant difference found in the resistin level differed according to the chronic kidney disease stage of progression as the hemodialysis patients have higher resistin levels than patients on conservative treatment. There was a highly significant decrease in resistin level after hemodialysis session than before.
Conclusion
Patients with chronic renal failure had higher serum resistin levels than the control group and it was found that resistin levels were more elevated in hemodialysis patients than patients on conservative treatment. So, it could be considered as a new diagnostic marker in chronic renal failure and serum resistin levels are reduced by hemodialysis treatment.

Keywords: child, electrolytes, kidney failure, renal dialysis and resistin


How to cite this article:
Tawfik MA, Soliman MA, Omar ZA, Elsawy Derbala SZ. Evaluation of serum resistin in children with chronic renal failure. Menoufia Med J 2020;33:173-8

How to cite this URL:
Tawfik MA, Soliman MA, Omar ZA, Elsawy Derbala SZ. Evaluation of serum resistin in children with chronic renal failure. Menoufia Med J [serial online] 2020 [cited 2020 Mar 30];33:173-8. Available from: http://www.mmj.eg.net/text.asp?2020/33/1/173/281300




  Introduction Top


Resistin, a currently defined adipokine, is a member of a family of proteins which can be located in inflammatory zones[1].

Resistin is expressed in low titers in human adipose tissue, pulmonary tissue, and resting endothelial cells and in excessive tiers in mononuclear leukocytes, macrophages, and in the spleen and bone marrow cells[2].

Continual kidney disease (CKD) is a growing purpose of difficulty 'over a' worldwide scale affecting populations of excessive, middle, and low-income international locations. It is far related to full-size mortality and morbidity, each, in adults as well as in kids. It is far critical to remember pediatric CKD other than adult CKD as they fluctuate with regard to epidemiology, etiology, evaluation, and management[3].

CKD is defined as abnormalities of the kidney structure or feature (described by means of markers of kidney harm or decreased glomerular filtration rate) for more than 3 months with implications for health (both criteria is enough for the diagnosis). (a) Markers of kidney damage (one or more). Albuminuria (albumin estimation charge ≥0 mg/24 h; albumin creatinine ratio ≥30 mg/g), urine sediment abnormalities, electrolyte, and other abnormalities because of tubular problems, abnormalities detected by means of histology, structural abnormalities detected by way of imaging and records of prior kidney transplantation. (b) Glomerular filtration rate of less than 60 ml/min/1.73 m2[4].

The aim of the work was to evaluate serum level of resistin hormone in children with chronic renal failure and its correlation with other clinical and laboratory parameters.


  Patients and Methods Top


This study is a case–control study of 96 children who were selected from the pediatric hemodialysis unit of Menoufia University Hospital; 64 children with chronic renal failure (CRF) who were classified into group A which included 34 patients with chronic renal failure under regular hemodialysis (18 men and 16 women), group B which included 30 patients with chronic renal failure on conservative treatment (18 men and 12 women) and 32 apparently healthy children were selected to constitute the control group from May 2017 to April 2018. Informed consents were obtained from the guardians of all patients. The study was approved by the Ethics Committee of Menoufia University.

The inclusion criteria: children aged from 6 to 18 years of both sexes with duration of chronic renal failure of 1 year or more.

Exclusion criteria for the patients: patients were excluded from the study if they were suffering from severe infections such as peritonitis or sepsis, receiving immunosuppressive drugs, or any history of disease that may affect liver function, tumors, and congestive heart failure.

All the included children were subjected to full history including personal history (name, age, sex, residence) and past history (diseases, drugs and operation) with special stress on the cause of CRF, disease duration, and dialysis duration.

Clinical examination: general examination (general look, posture, built, vital signs, limbs, colors, anthropometric measurement, and systems examination), neurological examination for psychiatric status, convulsion and thrombotic manifestations, chest examination (for pleural effusion and chest infection), and abdominal examination.

Laboratory investigation included complete blood count which was done on SYSMEX XN-1000 SA-01 (Kobe, Japan), urea, electrolytes [sodium (Na), potassium (K), calcium (Ca), phosphorus (Ph)] using AutoAnalyser (AU680; Beckman Coulter, Brea, California, United States); before the dialysis and serum resistin by enzyme-linked immunosorbent assay using the commercially available kit (Pelobiotech GmbH, Planegg, Germany); before and after the dialysis.

Data were collected, tabulated, and statistically analyzed using a personal computer with the Statistical Package for Social Sciences, version 20 for Windows (SPSS Inc., Chicago, Illinois, USA). Data were expressed as mean ± SD. Student's t test was used to assess the difference between the studied parameters in the two groups. The frequencies were expressed in %. χ2 was used to assess the difference between the studied frequencies in the two groups. Correlation coefficient (r) was used to evaluate the relation between the studied parameters in the same group. P was considered significant if less than 0.05 and highly significant if less than 0.001.


  Results Top


There was different causes of renal failure, the most common being unknown causes in 30 (46.9%) patients, obstructive uropathy in 23 (35.9%) patients, recurrent urinary tract infection in six (9.4%) patients, polycystic kidney disease in three (4.7%) patients, nephrotic syndrome in one (1.6%) patient, and atypical hemolytic uremic syndrome in one (1.6%) patient [Table 1].
Table 1: Data of studied chronic renal failure patients

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There was high statistical difference between the studied groups (hemodialysis patients, patients on conservative treatment, and control group) as regards weight (P < 0.001) and there was a significant difference as regards BMI (P < 0.001), while there was no significant difference as regards height (P > 0.001) [Table 2].
Table 2: Anthropometric measurements of studied groups

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There was high statistically significant difference between cases groups and control group as regards systolic blood pressure, diastolic blood pressure, hemoglobin, red blood cells count, and white blood cells count (P < 0.001) while there was a significant difference as regards pulse and hematocrit (P > 0.001) but there was no significant difference as regards temperature, respiratory rate, and platelet count (P > 0.001) [Table 3].
Table 3: Vital signs and complete blood count of studied chronic renal failure patients and control

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There was highly significant positive correlation between serum resistin and both creatinine and potassium levels and highly significant negative correlation between serum resistin to white blood cells count and platelet count, while there were a significant negative correlation between serum resistin and hemoglobin level and hematocrit level and a significant positive correlation between serum resistin and age, pulse, systolic blood pressure, height, and urea but nonsignificant positive correlation between serum resistin and diastolic blood pressure, weight, red blood cells count, sodium level, calcium level, and phosphorus level and nonsignificant negative correlation between serum resistin and BMI and duration of dialysis [Table 4].
Table 4: Correlations between resistin and other parameters

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There was a highly significant difference between the studied groups (hemodialysis patients, patients on conservative treatment, and control group) as regards urea, creatinine, potassium, calcium levels, and resistin level (P < 0.001) while there was a significant difference as regards sodium and phosphorous levels (P > 0.001) [Table 5].
Table 5: Renal function test, electrolytes and resistin of studied groups

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  Discussion Top


The present research showed that the median age of the case group was 13 years. Olowu et al.[5], who studied 154 CKD kids, determined that the median age was 10.0 years.

In the current study, we found that the percentage of men was more than the percentage of women (56.3% of patients were men and 43.8% were women), which consents with a preceding study which included 757 children 52.4% who were men[6]. But, this disagrees with another study which said that there was no sizeable sex distinction between control and sufferers institution[7].

In the current research, there was different causes of renal failure the maximum common cause turned into obstructive uropathy. Safouh et al.[8] determined in their observation about causes of CKD in Egyptian children that the most common causes of CKD included obstructive uropathy (21.7%).

There had been especially statistically enormous difference among groups (hemodialysis patients, patients on conservative treatment and control) as regards weight even as there have been a massive distinction between them as regards height and BMI. The results of our study have been also supported by Karupaiah et al.[9] who evaluated weight, height, and BMI in two groups of CRF patients; their outcomes revealed that weight, peak, and BMI have been notably better in sufferers with CRF versus controls (P < 0.001).

But our findings disagree with some other studies which concluded that increase and maturation have extensively progressed over the last two decades in German children with CKD. But, their evaluation of younger kids revealed continual top deficits[10]. Therefore, greater emphasis ought to be given on enhancing height gain in younger youngsters on renal replacement therapy to attain a similar growth in very last peak. The present study denoted that there was a great difference among the studied corporations (cases and controls) as regards systolic blood pressure with P = 0.001 which is not accepted as true with the examination performed with the aid of Warady and Chadha[11] where there has been no extensive difference between the companies concerning systolic blood pressure with P = 0.067.

The current study has shown that there was a great distinction between the studied corporations as regards diastolic blood pressure which disagrees with another study as they was no large distinction between the companies regarding diastolic blood strain with P = 0.809[6].

In our study, there was lower level of hemoglobin of sufferers became (9.40 ± 1.4 g/dl)[12].

Concerning renal capabilities in studied corporations we located that there had been exceptionally great difference among case groups and control institution as regards urea and creatinine, P value less than 0.001. Our study pass with preceding studies which proven that there was a statistically vast growth in serum creatinine and urea in sufferers in comparison to the controls [7, 13].

Inside the present study, there has been an extensive difference among the studied groups (hemodialysis sufferers, sufferers on conservative treatment, and control) as regards urea level with P = 0.001.

In the current study, there was an extensive distinction among the studied groups as regards calcium which is of the same opinion with a previous study wherein there has been a sizeable distinction in between the groups regarding urea level with a P value of less than 0.001[6].

We found that there was no extensive difference among the studied companies as regards phosphorus titer[6].

In the current study, there was a highly significant difference among the hemodialysis patients and controls as regards serum sodium stage which agrees with a previous study which observed that hyponatremia is common in CKD sufferers under hemodialysis due to quantity overload in which hypernatremia is not unusual[14].

Within the present study there was fantastically big distinction among hemodialysis sufferers and sufferers on conservative treatment and between hemodialysis patients and controls as regards resistin level while there has been no significant distinction among patients on conservative remedy and control as regards resistin stage.

Our records showed the association of renal characteristic with serum resistin level pronounced by way of Buyan et al.[15] in much smaller pediatric cohorts.

Additionally, our study has the same opinion with the outcomes obtained through preceding studies which determined that resistin degree is markedly accelerated in CKD patients than in normal kids. They stated that kidney is a critical place for resistin removal[16],[17].

In a recent observation we also found that there is incredibly large statistical difference in resistin stage according to the CKD stage as hemodialysis sufferers better than CKD sufferers under conservative treatment.

These consequences are just like that received by way of a previous study which determined that resistin level is higher in kids with CKD below everyday hemodialysis in comparison to those with CKD under conservative remedy. They found that resistin titers were 39.9 ± 1.3 ng/ml in hemodialysis institution and 23.2 ± 1.0 ng/ml for conservative institution[18].

But our study disagreed with Maggio et al.[7] who discovered that there has been no statistically considerable difference in resistin degrees in pediatric sufferers with CKD versus controls and they pronounced that resistin titers among sufferers have been an expression of an adequate dietary and metabolic status, and controlled inflammatory status: and consequently resistin might be a beneficial marker sufferers.

In the current study, there was highly negative correlation between serum resistin and hemoglobin stage, which concurs with the study by Maggio et al.[7], who observed that resistin offered an inverse correlation with hemoglobin (r=−0.475; P = 0.047).

In the present research, there was a significant positive correlation between serum resistin and age which is of the same opinion as that of Nehus et al.[19] who observed that serum resistin level extended with age (r = 0.15; P = 0.01).

In the current research, there has been nonsignificant negative correlation among serum resistin and BMI, which agrees with the study done by Silha et al.[20] who reported that resistin did not correlate with BMI.

Yannakoulia et al.[21] who studied the relation among resistin level and body fats mass in healthy humans They ibserved that serum resistin negatively correlated with BMI and body fats in young students. Also, Youn et al.[22] also discovered that plasma resistin concentrations showed a negative correlation with BMI.

Additionally, Briffa et al.[23] reported a massive terrible correlation between serum resistin and BMI. They stated that resistin has been proven to be stimulated with the aid of BMI.

In our study, there was surprisingly fantastic significant correlation among serum resistin and creatinine degree, which concurs with the observations by Pilz et al.[24] as they determined that resistin plasma awareness correlated with urea and creatinine and with that by Zein et al.[13] as they located that there has been a nonhuge tremendous correlation among resistin stage and serum creatinine (r = 0.092, P = 0.574) stage.


  Conclusion Top


This study showed that patients with chronic renal failure had higher serum resistin levels than the control group and it was found that resistin levels were more elevated in hemodialysis patients than patients on conservative treatment. So it can be considered as a diagnostic marker in chronic renal failure and serum resistin levels are reduced by hemodialysis treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Safouh H, Fadel F, Essam R. Causes of chronic kidney disease in Egyptian children. Saudi J Kidney Dis Transpl 2015; 26:806–809.  Back to cited text no. 8
    
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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