الفهرس 
KidneyOnly 14 pages are availabe for public view
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Abstract
Neonatal AKI is one of the frequent (NICU) complications. An elevation of the S.cr with a reduction in UOP is the diagnostic parameter of AKI. Yet, S.cr is not a reliable marker as it reflects kidney function, not damage, so its rise is significantly late. In addition; S.cr at birth reflects maternal serum levels. While sensitive, UOP is difficult to measure and is often preserved despite AKI due to tubular immaturity. Thus, many studies have been trying to detect a more reliable marker that reflects renal damage as soon as it takes place, even before the S.cr increases.
Cys-C is a low-molecular-weight (LMW) protein, subjected to filtration by the glomerular capillaries and reabsorption and metabolism by the proximal convoluted tubules, and not secreted. In addition; the available assay provides rapid detection of Cys-C and needs a few minutes until results are available. Besides that, preanalytic factors such as thawing and freezing cycles, storage conditions, or interfering substances such as triglycerides or bilirubin do not affect Cys-C assay. So, Cys-C is suggested to be an ideal early diagnostic marker of AKI.
We aimed to evaluate the value of Cys-C as an early marker of AKI in high risk neonates.
This cross-sectional analytical study was carried out on 176 newborns consecutively admitted to NICU at Berket-Elsaba General, Ministry of Health and Population, Menoufia Governorate, Egypt.in the period from 12/2021 to 6/2023.
The biological analyzes were carried out in the Medical Biochemistry and Molecular Biology clinical unit at the Faculty of Medicine, Menoufia university, Egypt.
All cases were subjected to through detailed history taking, clinical examination and Laboratory investigations included; serum urea and creatinine, serum Cys-C, arterial blood gasses, complete blood count, serum electrolytes (NA, K, Ca), C- reactive protein and blood culture (if indicated).
Patients were screened for AKI by performing serial measurements of S.cr levels during the first 48 hours after admission to assess changes in the estimated GFR as well as in the serum Cys-C level. AKI was defined by the neonatal «Risk Injury Failure Loss and End-stage (nRIFLE). eGFR-Cr were calculated using the Schwartz formula (eGFR = k x (height in cm) ÷ serum Cr) and eGFR-CysC were evaluated using the formula according to KDIGO guidelines: 70.69 × (SCysC) 0.931.
The results of our study revealed that:
1. 55.7% of the high risk neonates were males and 44.35% were females. The median of their GA was 38 weeks, 11.4% of them were born by normal vaginal delivery and 88.65% were born by caesarean section. The mean of their weight and length were 2.63±0.81 kg and 45.13±4.22 cm respectively. The median of the Apgar score at birth was 6. 2. Nearly half of the patients were on nasal oxygen therapy. 54.5% were receiving nephrotoxic drugs. The commonest nephrotoxic drug used was vancomycin (72.9%).
3. 33% of the neonates were CRP positive while the culture was positive in 71.8%. The commonest organism detected was klebsiella. 4. The means of the CBC parameters and serum electrolytes were within the normal ranges. The mean of the PH was showing mild acidosis. The mean levels of S.cr were 0.82±0.33 mg/dl and that of serum Cys-C was 11.27±4.09 mg/dl. 5. The mean of the GFR-creatinine was 27.17±13.76 ml/min/1.73m², the mean of the GFR- CysC was 8.10±2.34 ml/min/1.73m², and the mean reduction GFR % was 38.6±20.3. 6. 75% of the high risk neonates suffered AKI. They were classified as Risk (54.5%), injury (43.9%) and failure (1.5%). 7. 73.9% of the high risk neonates were survivors and 26.1% were nonsurvivors. 8. The mean of the age of the neonates with AKI (9.61±7.45 days) was significantly lower than that of neonates without AKI (14.41±9.95 days) (P< 0.05). 9. There was no significant statistical difference between high risk neonates with and without AKI as regard the supportive oxygen therapy and nephrotoxic drug administration (P> 0.05). 10. S.cr was significantly higher and Na level was significantly lower in the neonates with AKI than that of neonates without AKI (P< 0.05). 11. The GFR-Cr was significantly lower and the GFR reduction rate was significantly higher in the neonates with AKI than that of neonates without AKI (P< 0.05). While there was no statistical significant difference as regard the normal-GFR and GFR-CysC (P> 0.05). 12. There was no statistical significant difference between high risk neonates with and without AKI as regard the neonatal outcome (P> 0.05). 13. S.cr had higher accuracy (90.9%) than Cys-C (71.6%) in predicting occurrence of AKI. 14. Serum GFR-Cr had higher accuracy (86.4%) than GFR-CysC (72.7%) in predicting occurrence of AKI. 15. There was significant positive correlation between serum Cr and the neonates age, apgar score, urea, Cys-C and reduction GFR %, and significant negative correlation with the normal GFR and GFR- Cr (P <0.05). 16. There was significant positive correlation between serum Cys-C and serum urea and creatinine and significant negative correlation with GFR- creatinine and GFR-CysC (P <0.05). 17. There was significant positive correlation between reduction GFR % and the S.cr and significant negative correlation with the age and GFR- Cr (P <0.05).