الفهرس Only 14 pages are availabe for public view
 |  | from | 176 |  |  |
| | | from | 176 | | |
Abstract
Critically ill child” means a child who is in a clinical state which may result in respiratory or cardiac arrest or severe neurological complications, if not recognized and treated promptly. This term does not refer to any articular disease, but many diseases can lead to “critically ill state”.
Whether a child presents with a primary cardiovascular, respiratory,neurological, infectious or metabolic disorder, the goal is early recognition of respiratory and circulatory insufficiency. In clinical practice, there are three common situations that characterize a critically ill child: Respiratory distress, shock and altered sensorium. Parameters allowing regular evaluation of renal function in a Pediatric Intensive Care Unit (PICU) are not optimal.
Estimation of GFR is an important part in clinical evaluation of the renal function and of the management of renal diseases in children. The identification of patients with mildly impaired GFR in the so-called creatinine blind” area remains a challenge for pediatric nephrologists.
Inspite of the common use of creatinine and creatinine clearance(CrC) as markers of GFR, several factors may still contribute to false estimation of GFR. The serum creatinine production is proportional to the muscle mass, in contrary to cystatin C which is independent of gender and muscle mass.
Cystatin C is 120— amino acids, 13-kDa protein that is a member of the cysteine proteinase inhibitors family. It is involved in the intracellular catabolism of protein. Cystatin C is freely filtered by the glomerulus because of its small size and basic pH 9.0. It is not secreted but reabsorbed by tubular epithelial cells and subsequently completely catabolized, so that it does not return to the blood flow.