الفهرس 
Neonatal AsphyxiaOnly 14 pages are availabe for public view
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Abstract
Acute kidney injury (AKI), previously referred to as acute renal failure (ARF), represents a common and serious problem in clinical medicine. The incidence of AKI in neonates appears to be increasing, and the etiology of AKI over the past decades has shifted from primary renal disease to multifactorial causes, particularly in hypoxic ischemic neonates admitted to neonatal intensive care units with their different diagnoses.
Renal injury can be divided into pre-renal failure, intrinsic renal disease including vascular insults and obstructive uropathies. Despite significant improvements in therapeutics, the mortality and morbidity associated with AKI remain high due to the lack of early markers for AKI, and hence an unacceptable delay in initiating therapy. Acute kidney injury (AKI) is typically diagnosed by a progressive rise in serum creatinine over several days which may or may not be associated with oliguria, but changes in serum creatinine lag several days behind actual changes in glomerular filtration rate (GFR) and the alterations in serum creatinine are not particularly sensitive or specific for small changes in GFR. The detection of a reliable biomarker for early diagnosis of AKI would assist in facilitating early intervention, evaluating the effectiveness of the therapeutic intervention, and guiding pharmaceutical development.
This prospective study was carried out through 7 months to highlight acute kidney injury in critically ill neonates as well as investigating the role of serum neutrophil gelatinase-associated lipocalin in early detection of AKI among neonates admitted to NICU of Menofia University Hospital and Shebin EL Kom Teaching Hospital. The study included 25 patients whose ages ranged from 31 to 40 weeks, with a mean ± SD of 36.56 ± 2.43. Sixteen patients (64%) were males and 9 patients (36 %) were females and their weights ranged from 1.900 to 4.460 kg with a mean ± SD of 2.83 ± 0.65 kg. One serum sample was taken from patients in order to assess neutrophil gelatinase-associated lipocalin (NGAL) level and 2 serum creatinine samples for monitoring of kidney function. The 1st samples of both of them were taken upon enrollment and the 2nd samples were taken 48 hours later.
According to AKIN criteria, 7 patients (28%) were classified as grade I, 4 patients (16%) as grade II, 3 patients (12%) as grade I, while 11 patients (44%) had no evidence of AKI. Only 3 patients (12%) as grade III. while the other 38 patients (88%) didn’t require. Serum NGAL levels were statistically compared between patients who with AKI and those with no AKI. Results showed that while the 1st sCr sample was not an indicator of evident AKI, the sNGAL sample taken at the same time was significantly higher in patients with AKI and the 2nd sCr sample that was taken 48 hours later was higher in patients with AKI. This significant difference was noted at the same time when serum creatinine levels were still within normal range, being late in demonstrating the already developed AKI till 48 hours of admission. This could highlight the potential role of sNGAL as an early biomarker in predicting AKI in critically ill neonates prior to rise in serum creatinine. As regards the sensitivity, specificity of sNGAL as an early biomarker of AKI, it was found that sNGAL cut off value of 118 ng/ml has high sensitivity of 92.86% and specificity of 90.9%.