الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 131 |  |  |
| | | from | 131 | | |
Abstract
Acute kidney injury (AKI) is a common complication of critical illness, seven to ten percent of intensive care units patients present with AKI during their ICU stay. About 45-60% of them are associated with high mortality, It is important to prevent and to start early management of even the mildest forms of AKI to preserve renal functions and to prevent complications of AKI and to prevent the need for chronic dialysis, Because serum creatinin and oliguria are often late signs of significant acute kidney injury (AKI), more sensitive diagnostic tests are required. This clinical need has led to the development of multiple acute kidney injury (AKI) biomarkers. As acute kidney injury (AKI) biomarker levels change over time depending on the timing and severity of injury, a functional assessment of renal function might enhance biomarker performance. Since most common form (s) of intrinsic acute kidney injury (AKI) involve acute tubular injury and oliguria, Furosemide stress test (FST) was proposed for management of AKI via increasing urine output, Our study is a prospective cohort observational study that was conducted on eighty consecutive patients in the general ICU of Shebin Elkoum teaching Hospital divided into two groups:
a-group I: 40 consecutive patients who received Furosemide stress test following 80 mg Furosemide IV shots upon inclusion in the study.
b-group II: 40 consecutive patients who did not respond to 80 mg Furosemide IV shots and then received standard management by dialysis.
• In first 6 hours, there was a statistically significant increase in urine output in group I after 1st & 2nd hours (p value = 0.026, 0.008 respectively), as well as cumulative UOP over 6 hours (P value = 0.003),
as compared to group II, Cut off point for detection of progress using
(sum of 1st, 2nd hours) urine output found to be 325ml in group I with
sensitivity 86.7 %, specificity 68% and 325ml with sensitivity 95%, 95%
specificity in group II.
There was statistically significant decrease of serum creatinin level
in group 1 than group 2 in the first day (4.12 Vs 5.12 P value = 0.031),
however there was no significant difference in day 2 & 3 between two
groups (P value = 0.145 & 0.242 respectively), It’s noticed that there was
statistically highly significant difference between the two groups in day of
admission & day 1 only as (P value = 0.002, 0.019 respectively).
Glomerular filtration rate (GFR) is increasing progressively by time,
in group I by day 3 GFR improved from 15.78 to 24.37 ml/min/m2 while
in group II from 11.17 to 20.50 ml/min/m2 but there was no significant
difference between two groups.
The serum potassium was significantly higher in group I than group
II only in day 1 & 2 with P value (0.023), (0.005) respectively
Hypotension as a side effect in group I, eleven patients suffered from
hypotension representing (27.5%) where as no patients in group II
suffered from this side effect which is statistically significant (P value =
<0.001).
Fifteen (15) patients that representing (37.5%) progressed to AKIN
III in group I while in group II, 20 patients progressed to AKIN III
representing 50%. With no statistically significant difference between the
two groups (p value= 0.260), In group I mean length of stay was 4.81 ±
1.85 days with range from 3 to 10 days while in group II mean was 4.8 ± 2.38 with range from 3 to 14 days, with no statistically significant difference between the two groups (p value= 0.621), There was 5 (12.5%) patients who died in group I while in group II there was only one patient (2.5%) who died ,with no statistically significant difference between the two groups (P value= 0.201).
Furosemide stress test (FST) does not have an additional privilege over standard management (by dialysis) in the treatment of AKI. 81