الفهرس 
Chapter (I): KidneysOnly 14 pages are availabe for public view
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Abstract
AKI is defined as the abrupt loss of kidney function that results in a
decline in glomerular filtration rate (GFR), retention of urea and other
nitrogenous waste products, and dysregulation of extracellular volume and
electrolytes. The term AKI has largely replaced acute kidney failure
(AKF), as it more clearly defines kidney dysfunction as a continuum rather
than a discrete finding of failed kidney function.
ATF3 is a member of the ATF/cyclic AMP response elementbinding
(ATF/CREB) family of transcription factors. It is an adaptiveresponse
gene that participates in cellular processes, either pathological or
physiological such as maintenance of body homeostasis, wound healing,
cell adhesion, and tumor formation. Early diagnosis of AKI is the most
effective treatment method. So we must depend on a biomarker which can
be expressed early instead of depending only on serum creatinine which
has delayed expression. Other studies have founded that ATF3 was
expressed early in urine in AKI so uATF3 level can be used for early
diagnosis of the occurrence of AKI.
This study aimed to Clinically assess a group of Egyptian children
suffering from AKI to detect level of ATF3 gene expression for them and
reveal the role of ATF3 gene expression in development of AKI.
Our study was conducted on 25 children diagnosed as AKI from 298
children seeking medical advice (attendance rate) in the Pediatric
department and Nephrology clinic at Menoufia University Hospital from
January 2022 to december 2022. Another 25 children apparently healthy
matched to patient group in age, sex, socio-economic standard as control
group.
Summary
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The results of our study revealed that:
There was no significant difference between the studied groups
regarding their age, sex, family history and consanguinity (P value
>0.05).
Headache, convulsions and confusion were presented in 4(16%) of
cases. Tachycardia was found in 5(20%) of cases. Chest and GIT
examination were normal in majority of cases. Hematuria was found in
19(76%) of cases, oliguria was found in 22(88%) of cases and anuria
was found in 3(12%) of cases. Lower limb edema was significantly
found in 18(72%) of children with AKI.
Systolic and diastolic blood pressure (mm Hg) was significantly higher
among children with AKI (P value 0.001).No significant difference
regarding respiratory and heart rate (P value >0.05). Urine output was
significantly lower in AKI children than controls 0.50±0.25 vs
2.20±0.51 (P value 0.001).
Weight (Kg) was significantly higher in cases than controls (P value
<0.05). There was no significant difference regarding to the height (cm)
between cases and controls (P value >0.05).
Mean hemoglobin level (mg/dl) was significantly lower in AKI
children than controls 8.76±1.12 vs 11.8±0.67 (P value 0.001). Mean
WBCs level (*103/μl) was significantly higher in AKI children than
controls 9.21±4.09 vs 6.76±2.19 (P value 0.001).No significant
difference regarding platelet count (*103/μl) (P value >0.05).Mean urea
level (mg/dl) was significantly higher in AKI children than controls
93.0±37.1 vs 17.1±3.37 (P value 0.001). Mean creatinine level (mg/dl)
was significantly higher in AKI children than controls 2.58±1.94 vs
0.62±0.15 (P value 0.001). Mean PH level was significantly lower in
children with AKI 7.12±0.04 vs 7.37±0.02 (P value 0.001). Mean
Summary
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PaCO2 (mmHg) was significantly lower in children with AKI
34.0±3.20 vs38.9±2.58 (P value 0.001). Mean HCO3 (mmol/l) was
significantly lower in children with AKI 17.1±2.17 vs 23.7±2.44 (P
value 0.001). Total and ionized calcium levels (mg/dl) were
significantly lower in AKI children than controls 8.02±0.28 vs
9.53±0.58 and3.78±0.83 vs 4.65±0.26 respectively (P value 0.001).
Serum (Po4) (mg/dl) and Serum K (mmol/l) were significantly higher
in AKI children than controls 6.55±1.17 vs 4.68±0.78 and 6.02±0.32 vs
4.17±0.47 respectively (P value 0.001).
Ultrasound finding showed grades of bilateral nephropathy
The bilateral grade 1 nephropathy was found in 14(56%) of cases.
The Bilateral grade 2 nephropathy was found in 6(24%) of cases.
The Bilateral grade 3 nephropathy was found in 5(20%) of cases.
Statistically significant difference between both groups regarding
ATF3 gene expression (P value 0.001 ). On the other hand IL6
(ng/L) does not show any significant difference.
There was significant positive correlation between hemoglobin level
(mg/dl) and ATF3 gene expression (P value 0.001). There was
significant positive correlation between serum creatinine (mg/dl) and
ATF3 gene expression (P value 0.007).There was significant positive
correlation between serum K (mmol/l) and ATF gene expression (P
value 0.018).There was significant negative correlation between IL6
(ng/L) and ATF3 gene expression (P value 0.030). No significant
correlation with other laboratory investigations (P value >0.05).
At cut off point 21.4 ATF3 gene had sensitivity 88% and specificity
92% in detection of children with AKI