Dr. Wesam Elmenshawy Afifi Ibrahim :: Publications:

Background: Interleukin-18 is a protein which in humans which encoded by the IL18 gene .The protein encoded by this gene is a pro inflammatory cytokine which is a mediator of renal ischemia–reperfusion injury, causing acute tubular necrosis, and neutrophil and monocyte infiltration of the renal parenchyma, so urinary IL-18 level has been shown a good biomarker in predicting AKI . Aim The aim of this work is to study of urinary interleukin -18 as an earlier predictor of AKI in critically ill children. Methodology: Fifty critically ill patients were included in our study (22 males, 28 females), patients collected from the Pediatrics ICU, Pediatric Department, Benha University Hospital. During the period from January 2015 to January 2016. The following investigations were done for all patients: CBC, CRP, urea, creatinine, blood culture, Na, K, glucose, albumin, ABG, bleeding profile & urinary IL-18, urinary IL-18 were measured on admission & after 48 hours. Results: the incidence of AKI was 44%, 3 patients from them were received dialysis, the most common admission diagnosis was infectious causes (44.8%), Urinary interleukin 18 has higher both sensitivity (90.9%) & specificity (92.9%) & has both better positive predictive value & negative predictive value. Serum creatinine has higher specificity (100%) & lower sensitivity (68.2%) & has good negative predictive value, but low in positive predictive value. Urinary interleukin 18 is better in predication of AKI than serum creatinine, as we can see from ROC curve that interleukin 18 has higher area under the curve (0.947) than creatinine (0.908). The best cut values for urinary interleukin 18 & serum creatinine from ROC curve, for creatinine the best cut value is 0.35 with sensitivity 95.5% & specificity 75% while for urinary interleukin 18 we can see that the best cut value was 80 with high both sensitivity (95.5%) & specificity (92.9%) which con firms that interleukin 18 is a better in predication of AKI than serum creatinine. Conclusion: urinary interleukin -18 as an earlier predictor of AKI in critically ill children prior to rise serum creatinine.