Objective: This study aimed to assess the role of serum midkine (MK) as a biomarker for early detection of diabetic nephropathy in children with type 1 diabetes mellitus (T1DM) before microalbuminuria emerges. Methods: A total of 120 children with T1DM, comprising 60 microalbuminuric patients (Group 1), 60 normoalbuminuric patients (Group 2), and 60 healthy participants as a control group (Group 3) were included. Detailed medical history, clinical examination, and laboratory assessment of high-sensitivity C-reactive protein (hs-CRP), hemoglobin A1c percentage (HbA1c%), lipid profile, urinary albumin to creatinine ratio (ACR), serum MK and estimated glomerular filtration rate based on serum creatinine were performed in all participants. Results: Both Group 1 and Group 2 had significantly higher serum MK compared to controls (p<0.001). Additionally, significantly higher MK concentrations were present in Group 1 compared with Group 2 (p<0.001). Receiver operating characteristic curve analysis revealed that the MK concentration cutoff value of 1512 pg/mL was able to predict microalbuminuria with a sensitivity of 96% and specificity of 92%. Stepwise regression analysis revealed that HbA1c%, hs-CRP, and ACR were independently related to MK levels (p<0.001 for each). Conclusion: The results of this study suggest that serum MK is a useful, novel, practical marker for the evaluation of renal involvement in children with T1DM, especially in normoalbuminuric children.

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Background: Acute kidney injury (AKI) is an acute and reversible increment in serum creatinine levels regardless of associated or not with a decrease in urine output. AKI is very common among septic neonates. The high mortality among septic neonates with AKI stresses the need for screening them for renal failure. Early recognition of risk factors for AKI may reduce the risk of its occurrence. Objective: This study aimed to evaluate AKI's prevalence and outcome in neonates with neonatal sepsis in our hospital. Patients and methods: This study was an observational cross-section study carried out on all neonates ≥ 28 weeks admitted to our hospital in 6 months duration. History, examinations, and urine output were assessed and followed up regularly. Laboratory investigations included CBC, CRP, ESR, urine analysis, Urea and Creatinine, and Blood culture. Results: AKI presented in 67.2% of septic neonates based on oliguria while raised serum creatinine, shown in 4.5% of cases. Mean urine output was (1.26 ± 0.6) ml/kg/hr, 60 % of patients with AKI were males, 38% were preterm, 47% were LBW, and mortality was 51.1%. Conclusion: more than two-third of neonates with sepsis had AKI. Gestational age and weight were less in cases with AKI, with more than half of them were full-term and ≥ 2.5 kg. Gender was not a significant risk factor for AKI in sepsis. Mortality was significantly higher in AKI, mainly in full-term and low birth weight. Dead neonates with AKI were less anemic, less leucopenic, and more thrombocytopenic than living.