الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Sepsis is a severe and dysregulated inflammatory response to infection characterized by end organ dysfunction distant from the primary site of infection. Development of acute kidney injury during sepsis increases patient morbidity and mortality of critically ill pediatric patients. It is a clinical syndrome of multifactorial origin with numerous variables influencing its evolution and resolution. Recovery of kidney function is frequently possible if diagnosed early and treatment of causative factors instituted is the key of successful management of this condition in neonates.
The aim of this study was to determine the occurrence, types of acute kidney injury in septic neonates and identify the potential risk factors associated with its development as meningitis, shock, DIC, NEC, PDA, mechanical ventilation and administration of nephrotoxic drugs.
To achieve this goal, 100 septic newborn infants admitted to the neonatal intensive care unit at Alexandria University Maternity Hospital from September 2012 to April 2013 were included in the study. Patients were included in study if they had 2 or more clinical signs of sepsis and at least one laboratory finding suggestive of sepsis. Patients were diagnosed with acute kidney injury if blood urea nitrogen >20mg/dl and /or serum creatinine >1.5mg/dl on 2 separate occasions at least 24 hours apart.
All newborn infants enrolled in this study were subjected to thorough history taking, full physical examination, and biochemical markers to detect sepsis and acute kidney injury. Differentiation between prerenal and intrinsic renal disease has been done using fractional excretion of sodium (FENa), and renal failure index (RFI). Abdominal ultrasonography was only done when anomalies and obstructive uropathy was suspected.
Prevalence of AKI among the studied septic neonates was 20%. They were differentiated into 17(85%) with prerenal failure and 3(15%) with renal failure according to fractional excretion of sodium (FENa) and renal failure index (RFI). Nonoliguric renal failure was predominant constituting 75% of cases, with oliguria being only in 25% of the cases. The mean gestational age of the study population was 34 week and seventy percent of the studied group were preterms. Most of the cases had early onset sepsis. Mean age for development of AKI was 4.25 days. The most important risk factors for development of acute kidney injury in septic neonates were prematurity, low birth weight, shock, DIC and metabolic acidosis.
Wide scaled epidemiological studies to better understand the exact incidence and short and long term outcomes of AKI among septic neonates are greatly needed.