| Abstract: |
Despite advances in the provision of hospitalized care, the incidence of acute kidney injury (AKI ) is increasing and remains an independent predictor of morbidity and mortality. Acute kidney injury (AKI ) is a clinical problem with an estimated incidence of 5 – 30 % in hospitalized patients . In Intensive Care Unit ( ICU )the prevalence of patients with AKI requiring hemodialysis is approximately 6 % with associated mortality of 60 % . The proposed diagnostic criteria for AKI are an abrupt (within 48 hours) absolute increase in the serum creatinine concentration of ≥ 0.3 mg/dL from baseline, a percentage increase in the serum creatinine concentration of ≥ 50 percent, or oliguria of less than 0.5 mL/kg per hour for more than six hours. Serum creatinine increases late in case of kidney injury when a variable amount of kidney function has already been lost . serum creatinine as well as BUN and urine markers of kidney injury (fractional excretion of sodium, urinary concentrating ability , casts ) do not directly reflect cell injury, but rather the delayed functional consequences of the damage. Serum creatinine concentrations also may be affected by age , gender , ethnicity , dietary protein intake , hydration status , drugs and may remain within the reference range despite marked renal impairment in patients with low muscle mass . NGAL was originally identified as a 21 kDa protein covalently bound to gelatinase in neutrophils , and is normally expressed at very low levels in several human tissues, including kidney, lungs, stomach, and colon. NGAL expression is markedly induced in injured epithelia. NGAL was identified by micro array analysis as one of the earliest and most robustly induced genes and proteins in the kidney after ischemic or nephrotoxic injury in animal models. NGAL protein was easily detected in the blood and urine soon after acute kidney injury. Thus, NGAL might represent an early sensitive and non-invasive biomarker for acute renal injury. Urinary NGAL is emerging as a center-stage player in the AKI field, as a new predictive biomarker. Plasma NGAL measurements may be influenced by several coexisting variables such as systemic infections , inflammatory conditions and malignancies; however, any relationship between plasma and urinary NGAL requires further clarification .The aim of this study was to test the hypothesis that whether urine NGAL could represent an early predictive biomarker of renal injury and to assess the relationship between urine NGAL and serum creatinine for estimating acute kidney changes , in patients with normal kidney functions who admitted to different ICUs .
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