الفهرس 
Acute Kidney Injury: Definition,Only 14 pages are availabe for public view
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Abstract
kidney injury is generally defined as ’an abrupt and sustained decrease in kidney function’. Acute Dialysis Quality Initiative (ADQI) workgroup formulated the Risk, Injury, and Failure, Loss, and End-stage Kidney (RIFLE) defines three grades of increasing severity of acute kidney injury - risk (class R), injury (class I) and failure (class F) - and two outcome classes (loss and end-stage kidney disease). It depends on serum creatinine and urine output as markers of renal function. Depending on traditional markers for renal functions, namely blood urea and serum creatinine, has led to unacceptable delay in diagnosis and in initiating treatment of AKI. Our study aimed at depicting the role of urinary interleukin-18 as an early biomarker for post-operative AKI. The present study included 40 patients that have been classified into 2 groups: Group 1(cardiothoracic group): included 15 patients who were underwent cardiothoracic surgery. Group 2(Non- cardiothoracic group): included 25 patients who were underwent non cardiothoracic surgery. The selected patients were subjected to: Pre-operatively: history taking, full clinical examination, laboratory investigations in the form of blood urea and serum creatinine, CBC, serum albumin, serum sodium, serum potassium, ALT, AST, prothrombin time and concentration and urine analysis and e-GFR. Intra-operatively: The duration of the operation, Volume depletion and the need for transfusion of blood or blood constituents. Post-operatively: Samples were collected after 24 and 48 hrs. Postoperatively for determination of: Serum Creatinine, BUN, Serum sodium and potassium levels and arterial blood gases (ABG). Urinary IL-18 measured in the first 24 hrs. and after 24 hrs. Urine Output during the first 48 hrs. Postoperatively also was measured. After that; the patients were observed for 3 days for the need for further management according to the outcome of the acute insult. Our patients were classified into 2 major groups according to RIFLE classification of AKI: RIFLE group who met the RIFLE criteria of AKIN and Non RIFLE group who did not meet the RIFLE criteria or did not had AKI. Of the cardiothoracic group (n: 15) 6 patients met the RIFLE criteria of AKIN and of the non-cardiothoracic group (n: 25) 8 patients met the RIFLE criteria of AKIN. The results of this study may be summarized as follows: • Il-18 can detect acute kidney injury as early as 6 hours from its occurrence and before elevation of the conventional markers by 48 hours at least. • Il-18 is (unlike the conventional markers) not influenced by age, sex and body mass index. • Il-18 after 24 hours has a sensitivity of 85.7 % and a specificity of 73 %. • Il-18 after 48 hours has a sensitivity of 71.4 % and a specificity of 92.3 %. Preoperative anemia, prolonged operative duration, massive intraoperative blood loss and intraoperative volume depletion were significant risk factors for development of postoperative acute kidney injury.