الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Nephrotic syndrome is characterized by a triad of heavy proteinuria (urine protein/creatinine ratio ≥200 mg/mmol or ≥3+ proteinuria on urine dipstick), hypoalbuminemia (<2.5 g/L) and edema. It is one of the most common pediatric glomerular diseases. Although 80–90% of patients are initially steroid sensitive, a similar proportion will suffer one or more relapses. Long term use of steroids has adverse effects such as diabetes mellitus, osteoporosis, obesity, poor growth, hypertension, and adrenal suppression. On the other hand, resistance to steroid has been shown to be the single most reliable predictor of progression to ESRD. Due to side effects of long-term use of steroid and steroid resistance in some nephrotic patients another immunosuppressant agent should be used with a small dose of steroid. CsA is the most commonly used immunosuppressant agent in treating difficult to treat nephrotic syndrome (SDNS, FRNS and SRNS). CsA plays a confounding role in the treatment of NS in children. It is a widely used in pediatric nephrology practice for the treatment of patients with (SDNS, FRNS and SRNS). An association exists between renal and inner ear disorders. This association may be genetically determined and manifest as Alport‘s syndrome. The organs of the inner ear and the kidney are physiologically similar in that both are concerned in maintaining the electrolyte concentration gradient. Children with NS have biochemical impairments which include hypocalcemia, hyponatremia, and hyperlipidemia. These biochemical abnormalities are known to cause hearing impairment. Many children with NS are treated with multiple courses of diuretics, which also cause ototoxicity. These factors increase the risk of hearing impairment in children with NS. The aim of this study was to evaluate effects of CsA on hearing status in children with idiopathic difficult to treat NS. This prospective cohort study was conducted at Pediatric Nephrology Unit of Tanta University. Over 12 months from December 2018 to November 2019. It was conducted on 30 children with idiopathic nephrotic syndrome. The Subjects will be divided into 2 groups: group I: 15 children with SSNS. group II: 15 children recently diagnosed difficult to treat INS (SDNS, FRNS and SRNS) who will start CsA (5mg/kg/day). Patients were subjected to history taking including (age, gender, age at first clinical presentation, systemic diseases, ear problems, previous ENT operations and ototoxic drug intake). Laboratory data CBC, as blood urea, serum creatinine, cholesterol level and serum albumin were done, urine protein (24hour protein and Urine protein / creatinine ratio) also evaluated. Basic audiological evaluation including (Pure Tone Audiometry and extended high frequency range, Speech Audiometry, Acoustic Immitancemetrey and Transient evoked otoacoustic emissions (TOAEs) were done at the beginning of the study and after 6 months after initiation of CsA treatment for group II.