الفهرس 
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Abstract
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common and serious postoperative complication of cardiac surgery that employs cardiopulmonary bypass (CPB), and it is the second most common cause of AKI in the intensive care unit (ICU)
It is defined as increase in SCr by < 0.3 mg/dl (< 26.5µmol/l)within 48 hours; or increase in SCr to <1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or urine volume > 0.5 ml/kg/h for 6 hours .
It is characterized by an abrupt deterioration in kidney function following cardiac surgery as evidenced by a reduction in the glomerular filtration rate. Importantly, this deterioration may not be detected in the first 24–48 hours using conventional monitoring by serum creatinine (sCr) levels because of the dilutional effects of the CPB pump prime.
Since the early stages of AKI are often reversible, AKI should be prevented and/or treated by various approaches instituted as early as possible after the initiating insult, well before serum creatinine even begins to rise. The rise in serum creatinine is slow following the onset of AKI. Different urinary and serum proteins have been intensively investigated as possible biomarkers for the early diagnosis of AKI .
There are promising candidate biomarkers with the ability to detect an early AKI. They include:Neutrophil gelatinase-associated lipocalin (NGAL), Interleukin-18 (IL-18), Kidney Injury Molecule-1 (KIM-1), Growth related oncogene-α (Gro- α), Fetuin-A ,Cystatin C, α1-microglobulin, Meprin,N-acetyl-β-(D)-glucosaminidase (NAG), Na+/ H+ Exchanger Isoform 3(NHE3) and Retinol Binding Protein.
So in our study we aimed to predict early acute kidney injury following cardiac surgery before the rise in serum creatinine , by measuring serum NGAL, IL-18 and Cystatin C at days 1,2 and 3 post operatively .
The present study was carried out at the Clinical Pathology Department, Faculty of Medicine ,Minia University. It was conducted on 25 patients selected from patients who were subjected to cardiac surgery at Cardio-Thoracic Surgical Department of Minia University Hospital, through the period from September,2014 to June, 2015 and proved that they developed A K I after the surgery as manifested by an absolute increase in serum creatinine of 0.3mg/dl or more , equivalent to a percentage increase in serum creatinine 50% or more ( 1.5-fold from base line ) within 48 hours according to RIFLE and AKIN criteria . The study also included 15 apparently healthy volunteers who served as a control group of matched age and sex .