الفهرس 
Introduction and aim of the work
Chapter 1: Sepsis and Multiple Organ FailureOnly 14 pages are availabe for public view
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Abstract
- Sepsis and severe sepsis play a major factor in the development of acute renal failure in the ICU and mortality from sepsis-induced acute renal failure remains high despite our increasing ability to support vital organs. - Patients who develop acute renal failure in the setting of sepsis are more likely to die than dialysis-dependent patients with sepsis admitted to the ICU. - Small decrements in renal function are insufficient to be categorized as organ failure but these changes associated with increased morbidity and mortality. For this reason, the Acute Kidney Injury Network proposed the term of acute kidney injury in place of acute renal failure to encompass the entire spectrum of acute kidney dysfunction and the term acute renal failure is reserved for severe organ failure requiring specific supportive care. - AKI is routinely diagnosed by serum creatinine. Unfortunately, Serum creatinine is an unreliable indicator during acute changes in kidney function. - Early detection of sepsis induce AKI by biomarkers is an area of research priority and identification of novel AKI biomarkers has been designated as a top priority for early detection of sepsis induce AKI. - AKI is multifactorial in origin so it is likely that a panel of biomarkers will be required to early diagnosis, risk stratification, differentiate subtypes of AKI and to define the phase and severity of injury. - The uses of plasma and urine NGAL, KIM-1, IL-18 and cystatin C as a member of the putative ‘AKI panel’ have been initiated, robust assays for commercialization are nearly complete and the results are awaited with optimism. - While there are numerous biomarkers have been characterized for detection of AKI but few have been documented in septic AKI and available studies have notable limitations. - IL-18 was a predictor for subsequent deterioration in kidney function preceding clinically significant AKI by 24–48 h. So, these observations suggest that IL-18 may represent a useful early marker of AKI. - PAF, IL-18 and NHE3 most important biomarkers in detection of early kidney injury in sepsis. - Cystatin C, α1-M and IL-18 may have prognostic importance and forecast the need for RRT and mortality. - NGAL appears to be most sensitive and specific biomarker in relatively uncomplicated patient populations with AKI. - Specific pharmacologic treatment of ARF in sepsis give an apparent success in animal models with prevention of both mortality and renal failure but the beneficial effects of these strategies in humans need to be more investigated.