الفهرس 
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Abstract
Acute kidney injury (AKI), formerly called acute renal failure (ARF), is commonly defined as an abrupt decline in renal function, clinically manifesting as a reversible acute increase in nitrogen waste products, measured by blood urea nitrogen (BUN) and serum Creatinine levels(SCr), over the course of hours to weeks. This definition requires measuring the magnitude of SCr rise from “baseline” steady-state SCr. There is no baseline steady-state SCr in neonates, as SCr should be physiologically decreasing postnatally. After birth, serum Creatinine reflects the maternal renal function up to 72 hours of life (Filler et al., 2014).
AKI is common in neonates who require admission to the neonatal intensive care unit (NICU) (Selewski et al., 2015; Jetton et al., 2017). Compared to older infants, neonates have certain physiological characteristics that increase the risk of AKI, including higher susceptibility to hypo-perfusion, higher vascular resistance, elevated plasma renin activity, and decreased reabsorption of sodium in the proximal tubules (Selewski et al., 2015).
AKI is particularly common among critically ill neonates in intensive care units (ICUs) and is an important determinant of morbidity and mortality in these infants, many of whom were born with LBW or prematurely (Selewski et al., 2015). Such infants are more likely than full-term or normal-birth weight infants to have been exposed during intrauterine life to factors that can induce fetal distress, including IUGR, infection, placental insufficiency or maternal medications (Selewski et al., 2015). So the most common risk factors associated with AKI are sepsis, prematurity, obstructed labor and exposure to nephrotoxic drugs
This prospective cohort study was conducted in neonatal intensive care unit of Beni-Suef University Hospitalover 12 months period (from August 2020 to August 2021).All neonates were subjected to full history taking, clinical examinationand urine output was calculated every 8 hrs in addition to laboratory studies (CBC, CRP, Serial measurements of serum urea and creatinine, arterial blood gases, blood, urine and sputum cultures and serial measurements of Na, K).
Incidence of AKI among neonates admitted at our NICU and enrolled in our study was 22.9%. Nearly half (51%) had stage 1 mild neonatal AKI, whereas 32.3% had stage 2 neonatal AKI and 16.7% had stage 3 neonatal AKI.
In our study, prematurity, LBW, RDS, shock, sepsis, UTI, infection with Klebsiella, NEC, HIE, the need for inotropes and respiratory support were significantly associated with the development of AKI.Regarding antibiotics in our study, we found that nephrotoxic antibiotics especially ciprofloxacin, levofloxacin and Polymyxin, were significantly associated with the development of AKI
Sepsis markers include anemia, bandemia, thrombocytopenia, hypoperfussion with metabolic acidosis so all these markers were highly associated with development of AKI. In our study, out of 102 cases of AKI, there were 92 (90.2%) cases with neonatal sepsis.
Regarding outcome, AKI prolonged the duration of hospital admission significantly (p.value was 0.002). In our study there was a significant difference between mortality rate among AKI patients (75.5%) and mortality rate among non AKI patients (26.8%) with P.value <0.001.Sepsis and HIE are major cofactors of mortality in AKI.In our study, 77 (75.5%) of 102 AKI patients died and 25 (24.5%) survived despite we had 57 (56%) patients with AKI improved, 32 (31%) patients deteriorated and 13 (13%) patients had stationary course till death.
In our cohort, 23 patients out of 102 patients with AKI (22.5%) needed peritoneal dialysis, there was a significant positive correlation between baseline Creatinine and need for PD (Pearson coefficient 0.560, Significance 0.000).