الفهرس 
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Abstract
AKI affects approximately 35% of intensive care unit (ICU) patients, and close to 50% of AKI is secondary to sepsis. Thus, sepsis-induced AKI probably occurs in somewhere between 15 and 20% of all ICU admissions. The lack of a uniform definition of AKI in adults and children has lead to the adoption of a new classification system entitled the RIFLE criteria as a standardize criteria for AKI in adults and has been adapted for paediatric patients. The pediatric RIFLE (p-RIFLE) classification better reflects the course of AKI in children admitted to the intensive care unit. The new classification system aims to standardize the definition of AKI based on changes in serum creatinine from baseline, a decrease in urine output, as well as the length of renal replacement at later stages. Acute kidney injury (AKI) is a frequent and serious complication of sepsis in intensive care unit (ICU) patients, Moreover, there is strong evidence that sepsis and septic shock are the most important causes of AKI in critically ill patients, account for 50% or more of cases of AKI in ICUs, and associate with a very high mortality. Furthermore, there is evidence that even less severely ill patients with infection (patients with non-severe pneumonia) have a significantly higher incidence of AKI and increased immune responses. Although septic shock is a leading cause of AKI, the underlying mechanisms are not completely known. Despite extensive research and progress in several other fields, the incidence, as well as mortality of septic AKI, remains unacceptably high. The aim of the present work was to study the risk of developing AKI in hospitalized pediatric patients Secondary to Infectious Disease in Intensive Care Unit. This study involved 90 children with infectious diseases admitted to the PICU in of Tanta university hospital. All children were subjected to: • Full history taking. • Clinical examination. • Investigation: ❖ Complete blood count. ❖ C-reactive protein. ❖ Blood urea nitrogen and creatinine clearance. ❖ 24 hours Urine volume. ❖ Blood culture. ❖ pRIFLE. ❖ PIRO system evaluation. In this study, blood samples were taken on admission, at the 3rd and the 7th days. The results were: 1. Serum Creatinine was high in cases who were suffering from kidney injury. 2. Serum Creatinine was high in cases that were staying longer in PICU. 3. Blood urea was high in cases who were suffering from kidney injury. 4. Blood urea was high in cases that were staying longer in PICU. 5. Estimated Creatinine Clearance was low in cases that were staying longer in PICU. 6. There was association for the severity of pRIFLE with AKI. 7. Mortality was high in cases who were suffering from kidney injury. 8. There was association for the severity of pRIFLE with mortality in early AKI. In spite of that, septic patients were chosen in this study, the WBCs count was only around the upper normal limit. Except for single significant increase, no other significant differences were noticed throughout the studying period. On the contrary, C-reactive protein was increased in all groups throughout the study. However, as with WBCs, except for double significant increase, no other significant differences were noticed throughout the studying period. Serum creatinine was increased in early AKI compared with no-AKI throughout the study. The rate of change and change after 7 days were more expressive with increase in early AKI and late AKI compared with group no-AKI. In advocacy with that were results of blood urea Even better, eCCl showed more discrimination increased in late AKI compared with Groups no-AKI and early AKI on admission. That was enforced when it increased in no-AKI and late AKI compared with Early AKI. That was supported by the rate of change and change after 7 days i.e. no-AKI > late AKI > early AKI. The mentioned image was reinforced when applied on mortality between studied groups, i.e. no-AKI > late AKI > early AKI. Not surprising, the pRIFLE classification showed significant association for the severity of pRIFLE with mortality in early AKI. The statistical non-significance in late AKI may be due to the small number of the studied cases (may be the issue with LOS). In the meantime, PIRO staging system showed significant association with mortality. Ironically, there a significant difference between expected & observed hospital mortality in stage I& stage II (may be due to the small sample size). In this study Goldstein et al., (80) classification was the base; PIRO system should be investigated furtherly in order to become a true patient staging system with real treatment and prognostic implications in sepsis patients. In conclusion, patients who developed AKI during their PICU (sepsis, hypotension, use of diuretics, nephrotoxic drugs and mechanical ventilation put their prints) stay showed worse prognosis (early AKI was the worst) than those with no-AKI. It is recommended to: Use the pRIFLE staging as a key in the AKI guideline; definition, staging and prognosis. Use C-reactive protein in sepsis detection (not grading) better than WBCs count (absolute neutrophil count may give another picture) Multi-measure sCr and blood urea to give better results and evaluation than single measure. Use eCCl as a better expression for renal functions than sCr and blood urea. Monitor patients with sepsis, hypotension, use of diuretics, nephrotoxic drugs and mechanical ventilation during their PICU stay for the development of AKI. Use Goldstein et al., (80) classification as a base for sepsis diagnosis ; PIRO system need to be investigated furtherly in order to become a true patient staging system in sepsis patients. Multi-center study with large number of cases is recommended for establishment of conclusions.