الفهرس 
Acknowledgement
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Abstract
The underlying pathologic changes are partly irreversible, and a prompt diagnosis with early initiation of treatment is of vital importance. The diagnosis is based on clinical, laboratory, and conventional US findings, whereas renal biopsy is considered the reference standard for a definitive diagnosis and fibrosis grading.
Unfortunately, this invasive procedure is associated with the risk of serious bleeding complications and therefore is not the method of choice for longitudinal monitoring.
Elastography, a Novel imaging modality that estimates tissue stiffness, especially for superficial organs such as the breast and Thyroid. In recent years, ultrasound elastography (UE) has been demonstrated in the liver and has been applied widely in the diagnosis and evaluation of liver diseases, such as chronic hepatitis, alcoholic liver diseases, and non-alcoholic fatty liver diseases. To date, renal allograft stiffness (elasticity) has been evaluated by magnetic resonance elastography (MRE) and ultrasound elastography (UE). US time-harmonic elastography depicts abnormal renal stiffness in glomerulonephritis, particularly among patients with early disease and preserved renal function.
This study aimed to assess the diagnostic performance of US time-harmonic elastography for the early detection of different subtypes of glomerulonephritis in children.
This prospective study was conducted at Assiut University Children’s Hospital. Pediatric Nephrology Unit from January 2021 to December 2022
The main results of the study revealed that:
● No significant differences between cases and control groups regarding age in years and but there is significant difference regarding gender (p>0.05).The mean age in the case group was 8.20± 3.52 years, ranged from 2 years to 16 years with male to female ratio of ” ” " ~ " ” ”1.4 : 1
● A significant increase in blood pressure of the studied cases with no significant differences between the two groups regarding other vital signs including heart rate, respiratory rate and temperature
● Significant decreases in hemoglobin concentration, Na+ and albumin levels, C3& C4 levels (in 92.5% and in 17.5% of the studied cases respectively) with significant increases of the rest lab. values among studied cases on admission compared to their levels with control group except for serum albumin levels.
● Decreased C3 only without corresponding decrease in C4 levels was detected in 75% of the studied cases. lowering of both C3 and C4 was detected in 17.5% of the studied cases.
● ANA and Anti Ds DNA were positive in 17.5% of studied cases which were related to lupus nephritis
● Renal biopsy was done in only (14/40) of studied group (35%) as 25 of the studied 40 cases (62.5%) were diagnosed as PSGN and all of them made a full recovery, with most clinical symptoms resolved spontaneously within 2 – 3 weeks after onset. One case was missed (1/40) (2.5%).Rapidly progressive glomerulonephritis (RPGN) (Crescentic GN) and Diffuse proliferative glomerulonephritis (DPGN) were suggested as possible diagnosis based on biopsy findings in (10/40cases=25%) and (4/40 cases=10%) respectively. Among those two types 4/14 cases (28.57%) were diagnosed as lupus nephritis and 2/40 cases needed dialysis.
● A significant difference between the two groups regarding echogenicity (p<0.001). (72.5% of cases had grade 1, 5% had grade 2 and 22.5% were normal while, all children in control group reported normal echogenicity) with no significant differences between them regarding renal span, transverse diameter and cortical thickness.
● Similar to the results of the right kidney a significant difference was observed between the two groups regarding echogenicity (p<0.001) with no significant difference between them regarding renal span, transverse diameter and cortical thickness of the left kidney.
● Significant elevation in ARFI-e measurement values was detected in comparing cases and control groups (p<0.001).
● By using ROC-curve analysis, renal elastography can differentiate acute glomerulonephritis from normal at cut off 3.98 with sensitivity, specificity, PPV and NPV were 100%, 92.5%, 93% and 100% respectively (p< 0.001).
● No significant relation in ARFI-e measurement values between diagnosed types of glomerulonerphritis in cases group (p>0.05).