الفهرس 
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Abstract
This prospective randomized double blinded study was conducted at cardiothoracic unit of Minia university hospital. Between April 2016 and January 2017, 50 patients aged from 18-60 years old, of both sexes, ASA physical status II or III underwent elective valvular cardiac surgery using cardio pulmonary bypass (CPB), were enrolled in this study.
This study aimed to evaluate the novel biomarker urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) as an early predictor (within 2 hours after the end of surgery) of acute kidney injury (AKI) in adult patients undergoing cardio-pulmonary bypass (CPB) for cardiac surgery. And testing the hypothesis that pre-treatment with minocycline for those patients undergoing cardiac bypass surgery protects against developing acute kidney injury.
Patients were randomly allocated into one of two groups. Study group (group A, n=25): patients received Minocycline Capsules in the dose of 200 mg initially, then 100 mg every 12 h until surgery. Control group (group B, n=25): patients received placebo (at the same dose regimen). The two groups were compared with respect to:
Hemodynamic data: MAP, HR, Temperature and O2 saturation values were recorded (Preoperatively, Just after induction, 15 min after induction, 15 min after CBP initiation, 15 min after CBP termination, Immediately Postoperative, and at 6, 12. 24 h postoperatively).
Perfusion Data: Cardio Pulmonary Bypass (CPB) time, Aortic Cross-Clamp time, Hemodilution (Hematocrit level) and Method of weaning of bypass either without support, on minimal or high dose pharmacological support.
Peri operative fluid intake and UOP: Intraoperative and postoperative fluid infusion, blood transfusion and urine output were recorded.
ICU Data: Hemodynamic changes, ABG, Time for extubation were recoded.
length of ICU stay: The length of ICU stay for all patients in both groups were recorded.
AKI incidence: The incidence of AKI was compared in the two groups.
Need of dialysis and Mortality: The need of dialysis, ICU mortality and 30-day mortality (followed by telephone) were recorded in both groups.
Adverse effects or complication: Any side effects related to Minocycline were reported and compared in both groups.
Laboratory investigation:
Non-specific: routine investigation for liver function, complete blood picture, and coagulation profile were recorded.
Specific: Renal Function Tests, estimated Creatinine Clearance was evaluated preoperatively, Blood Urea and Serum Creatinine evaluated preoperatively and at 2, 6, 12, 24, and 48 hours post operatively and uNGAL evaluated preoperatively and at 2, 24 hours post operatively in both groups. Based on the incidence of AKI, patients were subdivided into two groups: (AKI group) and (non-AKI group).
The results revealed that there no statistically significant differences between Minocycline group and Control group in all assessed parameters. Regarding AKI 8(32%) patients developed AKI in Minocycline group and 9 (36%) patients developed AKI in Control Group. And serum creatinine and blood urea nitrogen show slight increase in AKI group 12-hour post operatively, significant increase occur after 24 hours operatively, while uNGAL shows significant increase in AKI group 2-hour post operatively.
Our results showed significant difference between AKI group and non-AKI group regarding Cleveland score, CPB duration, ACC duration, Intra-operative blood transfusion, Adrenalin drug use and ICU stay.