الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
AKI is characterized by an abrupt deterioration of renal function within a duration of less than a week. According to the international club of ascites criteria (ICA), AKI is defined as increased serum creatinine (sCr) ≥ 0.3 mg/dl above baseline (last sCr obtained within 3 months of hospital admission, or if not available sCr at time of admission could be used) within the last 48 hours, or ≥ 50% increase in serum creatinine above baseline that is presumed to have occurred within the last 7 days.
AKI may have many etiologies, the most common of which are PRA, HRS and ATN. Currently, there is lack of a clinical biomarker that quickly and accurately discriminates different etiologies of AKI.
Nearly 30 biomarkers of kidney tubular injury have been investigated for early detection, differential diagnosis and prognosis of AKI in cirrhosis. Neutrophil gelatinase associated lipocalin is a 22kdalton protein. Its synthesis is markedly increased in both proximal and distal tubular kidney injury.
TFF-3 is a member of the trefoil factor peptide family that in the kidney is predominantly produced by epithelial cells of the proximal and distal tubules and cortical collecting duct that appears to play a role in tubular regeneration early after injury.
The present study was done to investigate roles of urinary NGAL, urinary TFF3 and echocardiographic parameters diagnosing circulatory dysfunction and cirrhotic cardiomyopathy in differentiating between the three most common etiologies of AKI in cirrhotic patients namely PRA, ATN and HRS.
This study was conducted in Alexandria University Hospital during the period from September 2017 till June 2018. It enrolled eighty patients with liver cirrhosis divided into four groups, twenty patients each and twenty healthy controls, five groups in total(n=100). group I included 20 patients with HRS(n=20), group II included 20 patients with PRA(n=20), group III included 20 patients with ATN(n=20), group IV included 20 patients with liver cirrhosis without renal impairment(n=20) and group IV included 20 healthy controls(n=20). Patients with chronic kidney disease (CKD), hepatocellular carcinoma (HCC), sepsis, acute liver failure (ALF) as well as urinary tract infection (UTI) were excluded from the study.