Urinary Activin A as Apredictive Marker for Assessement of Acute Kidney Injury Severity in Patient Admitted at Assuit University Hospital

Acute kidney injury has been ahealth problem all over the world , It's prevelance in developing and developed countries is increasing due to pre renal , renal , post renal causes .

Estimates of AKI prevalence range from <1% to 66%. These variations can be explained by not only population differences but also inconsistent use of standardized AKI classification criteria. The aetiology and incidence of AKI also differ between high-income and low-to-middle-income countries.(1)

• It can be presented in different stages according to AKIN classification (stage l (Increase in serum creatinine ≥0.3md/dl (≥26.4μmol/l) or increase to >150% to 200% (1.5 fold to 2 fold) from baseline , and urine output (<0.5 ml/kg/h for >6 h ))

• stage ll (Increase to >200% to 300% (>2 fold to 3 fold) from baseline) , and urine output (<0.5 ml/kg/h for >12 h ))
• stage lll(Increase in serum creatinine to >300% (>3 fold) from baseline, or serum creatinine >4.0mg/dl (>354μmol/l) with acute increase of atleast 0.5mg/dl ) Urine output(<0.3ml/kg/hr for 24 hours, or anuria for 12 hours). (2)
• In ischemic kidney, there is acytokine belong to the transforming growth factor (TGF)-B ( Activin A) that regulates the growth and differantiation of cell in variuos organs was significantly increasd in ischemic kidney . (3)
• level of Activin A in urine correlate to the severity of the acute kidney injury (AKI), as the level of urinary Activin A in first stages of acute kidney injury is less than the second and third stages . (4)
• so follow up of urinary Activin A in patients with acute kidney injury can be avery useful biomarker for assessement of severity of acute kidney injury. (4)

Inclusion criteria

• The study will include patient with acute kidney injury with no history of chronic kidney diseases

Exclusion criteria

• patient with history of chronic kidney diseases , diseases associated with icreased activin A level such as ( heart failure , cancers , COPD , systemic sclerosis ,pregnant , viral infection , and Mycosis Fungoides and Sézary Syndrom