الفهرس | Only 14 pages are availabe for public view |
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 98 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 99 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 |