الفهرس 
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Abstract
Acute kidney injury is considered a common adverse effect in surgical patients and is linked to significant rise in mortality, a risk for chronic kidney disease (CKD) and long-term renal dialysis and tremendous healthcare costs.
There is no perfect AKI treatment. The standard measure for AKI prevention and treatment is intravenous fluid therapy. It minimizes the ischaemic and toxic insults to the renal system.
However, the excessive intravenous fluid results in fluid overload especially if there is coexisting comorbidities. It can result in complications including the renal function affection.
Traditionally, there are two functional biomarkers used to define AKI. These are serum creatinine (sCr) and urine output (UOP). However, these markers readings are affected long after kidney injury and they have low sensitivity and specificity. Many new biomarkers can detect AKI earlier and can be more sensitive than sCr.
Recently, novel biomarkers including insulin-like growth factor binding protein 7 (IGFBP7) and tissue-inhibitor of metalloproteinases-2 (TIMP-2) have been proposed for early AKI detection. They are cell cycle arrest markers and represent “renal stress” rather than an established renal damage.
The aim of the present study was to assess the capability of early prediction of acute kidney injury using urinary G1cell cycle arrest biomarkers in patients undergoing major abdominal surgery managed by plethesmography based goal directed therapy.
After obtaining the approval from the Ethics Committee of the Faculty of Medicine, Alexandria University, and taking a written informed consent from patients, a single blinded prospective controlled randomized study was performed. Forty adult patients of both sex (after sample size calculation), physical status according to American Society of Anaesthesiologists (ASA) I and II who were planned for elective major abdominal surgery (was defined as any surgery with intra-peritoneal approach done under general anaesthesia and the predictable postoperative hospitalization and length of stay at least two days) with combined general epidural anaesthesia, admitted to Alexandria Main University Hospital.
Patients were randomly categorized using closed envelope technique into 2 equal groups (20 patients each).