الفهرس 
THE KIDNEYOnly 14 pages are availabe for public view
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Abstract
T
his prospective case control study was carried out in Neonatal Intensive Care Units, Ain Shams University Hospitals and Manshyet El Bakery Hospital from November 2019 to August 2020.
The Aim of the study is:
Primary aim: to study the effect of colistin on serum cystatin C as an early marker for renal affection in neonates.
Secondary aim: to follow up other kidney function tests (ex. serum creatinine, Glomerular Filtration Rate (GFR)) in same patients.
All neonates 30 or more weeks of gestation who received colistin for 5 or more days comprised the colistin (study) group with the following exclusion criteria:
Neonates with AKI evidence before colistin initiation.
Neonates with congenital malformations.
Neonates with evidence of hypoxic ischemic encephalopathy.
Neonates receiving concomitant drugs known to be nephrotoxic
Neonates who are hemodynamically un stable (shocked)
Neonates who are not receiving colistin served as non – colistin (control) group with the same exclusion criteria and were receiving antibiotics according to NICU protocol in Ain Shams University hospitals and Manshyet El Bakry Hospital.
All cases were subjected to comprehensive history taking, through clinical evaluation including vital signs evaluation and individual system examination.
Laboratory work up was done to all patients included blood samples for serum BUN, serum Creatinine, sodium, potassium and GFR was calculated using shwartz formula (Initially on admission and before colistin or antibiotics).
The previous lab work was sampled again together with serum cystatin C 5 or more days after colistin or antibiotics initiation and the two groups were compared together.
Cystatin C is more sensitive than Creatinine in detection of early kidney injury. Cystatin C is a serum protein that is filtered out from the blood by the kidneys and that serves as a measure of kidney function. Cystatin C is produced by type of nucleated cells in the body. Its low molecular mass allows it to be freely filtered by the glomerular membrane in the kidney, is used as alternative to creatinine and creatinine clearance for screening kidney function in those with known or suspected kidney diseases.
The two groups were comparable regarding sex distribution, gestational age and risk factors.
We then concluded the following
• Colistin affects serum cystatin C which showed higher values in colistin group patients than non-colistin group patients given other antibiotics.
• This denotes its potentially hazardous effect on the neonatal kidney.
• Serum cystatin C is an early, sensitive and specific marker of acute kidney injury in neonates which may not be detected by traditionally used kidney function tests or Kidney Disease Improving Global Outcome (KDIGO) criteria of acute kidney injury in neonates (which combines aspects of both RIFLE and AKIN to provide a single tool for use in both research and clinical practice)
• Initial low potassium levels ( even though within normal ranges ) was related with higher serum cystatin C levels
• Premature patients showed higher incidence of acute kidney injury than full terms during colistin administration.
• There is diversity according to different studies in the effect of colistin on serum electrolytes which needs more studies to confirm.