Acute kidney injury after cardiac surgical operations specially including coronary artery bypass graft operations

Authors

  • Adam Lipski Students' Scientific Association of Cardiac Surgery, Department of Cardiac Surgery, Jozef Strus Hospital, Poznan, Poland
  • Marta Szymoniak-Lipska Students' Scientific Association of Cardiac Surgery, Department of Cardiac Surgery, Jozef Strus Hospital, Poznan, Poland
  • Krzysztof Greberski Department of Cardiovascular Prevention, Poznan University of Medical Sciences, Poland Department of Cardiac Surgery, Jozef Strus Hospital, Poznan, Poland

DOI:

https://doi.org/10.20883/medical.e34

Keywords:

acute kidney injury, cardiac surgery associated kidney injury, renal replacement therapy

Abstract

Introduction. Acute kidney injury as abrupt loss of kidney function leads to accumulation nitric and non-nitric metabolites, toxins. It coexists with deep disorder of fluid balance. Most of cardiac surgical operations are performed using extracorporeal circulation (ECC). To the main risk factors of the postoperative dysfunction of kidneys belong: age above 70, congestive heart failure, previous CABG, preoperative creatinine concentration 124–177 µmol/L, diabetes type I, glucose concentration > 16,6 mmol/L, EEC longer than 3 hours and decreased cardiac output (CO).
Material and methods. The serum creatinine is not enough sensitive marker to diagnose early period of acute kidney injury because the serum creatinine increase occur later than true GFR changes and it needs time to accumulate. It depends on factors like: age, sex, weight, hydration status and what patient eat. NGAL (neutrophil-gelatinase associated lipocalin), cystatin C, KIM-1, IL-18, L-FABP are new markers of acute kidney injury which better than the serum creatinine concentration correspond with kidney injury. The risk factors of the acute kidney injury (AKI) are kidney hypoperfusion, microembolisation by bubbles or material particles and significant activation of humoral factors.
Results. One of the methods reducing mortality CSA-AKI (cardiac surgery associated kidney injury) is renal replacement therapy (RRT), which should be used in early period of acute kidney disease before severe symptoms and complications develop.
Conclusions. There is necessity to find early, easy and cheap markers of acute kidney injury which help decide if use renal replacement therapy. It increases the effectiveness of treatment and improves prognosis in this group of patients.

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References

Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P and the ADQI workgroup: Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Critical Care. 2004;8:R204–R212.

Mangano CM, Diamondstone LS, Ramsay JG et al. Renal dysfunction after myocardial revascularization: Risck factors, adverse outcomes, and hospital resourse utilization. Ann Intern Med. 1998;128:194.

Tuttle KR, Worrall NK, Dahlstrom LR et al. Predictors of ARF after cardiac surgical procedures. Am J Kidney Dis. 2003;41:76.

Kokot M, Duława J. AKI – ostre uszkodzenie nerek – współczesne spojrzenie na zagadnienie ostrej niezapalnej niewydolności nerek. Nefrol Dial Pol. 2009;13:164–170.

Palevsky MP, Murrat PT. Acute Kidney Injury and Critical Care Nephrology. NephSAP. 2006;5:72.

Sutton TA, Fisher CJ, Molitoris BA. Microvascular endothelial injury and dysfunction during ischemic acute renal failure. Kidney Int. 2002;62:539.

Sreeram GM, Grocott HP, White WD et al. Trancranial Doppler emboli count predicts rise in creatinine after coronary artery bypass graft surgery. J Cardiovasc Vasc Anesth. 2004;18:548.

Gutteridge JMC. Iron promoters of the Fenton reaction and lipid peroxydation can be releeased from hemoglobin by peroxidie. Fed Eur Biochem Soc Lett. 1986;201:291.

Bonventre JV, Zuk A. Ischemic acute renal failure: An inflammatory disease? Kidney Int. 2004;66:480.

Burne-Taney MJ, Rabb H. The role of adhesion molecules and T cells in ischemic renal injury. Curr Opin Nephrol Hypertens. 2003;12:85.

Frering B, Philip I, Dehous M et al. Circulating cytokines in patients undergoing normothermic cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2002;21:232.

Kinsey GR, Li L, Okusa MD. Inflammation in acute kidney injury. Nephron Exp Nephrol. 2008;109:e102.

Kirklin JK, Westaby S, Blackstone EH et al. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1983;86:845.

Musial J, Niewiarowski S, Hershock D et al. Loss of fibrinogen receptors from the platelet surface duringsimulated extracorporeal circulation. J Lab Clin Med. 1985;105:514.

Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: Patophysiology and treatment. An update. Eur J Cardiothorac Surg. 2002;21:232.

Sheridan AM, Bonventre JV. Cell biology and molecular mechanisms of injury in ischemic acute renal failure. Curr Opin Nephrol Hypertens. 2000;9:427.

Mori K et al. Endocytic delivery of lipocalin siderophore-iron complex rescues the kidney from ischemia-reperfusion injury. J Clin Invest. 2005;115:610–621.

Mishra J et al. Amelioration of ischemic acute renal injury by NGAL. J Am Soc Nephrol. 2004;15:3073–3082.

Wagener G et al. Association between increases in urinary neutrophil gelatinase associated lipocalin and acute renal dysfunction after adult cardiac surgery. Anesthesiology. 2006;105:485–491.

Mishra J et al. Kidney NGAL is a novel marker of acute injury following transplantation. Pediatr Nephrol. 2006;21:856–863.

Parikh CR et al. Urine NGAL and Il-18 are predictive biomarkers for delayed graft function following kidney transplantation. Am J Transplant. 2006;6:1639–1645.

Hirsch R et al. NGAL is an early predictive biomarker of contrast induced nephropathy in children. Pediatr Nephrol. 2007;22:2089–2095.

Nickolas TL et al. Sensitivity and specificity of a single emergency department measurement of urinary neutrofil gelatinase associated lipocalin for diagnosing acute kidney injury. Am Intern Med. 2008;148:810–819.

Mishra J et al. Neutrophil gelatinase-associated lipocalin, a novel early urinary biomarker for cisplatin nephrotoxicity. Am J Nephrol. 2004;24:307–315.

Bachorzewska-Gajewska H et al. Neutrophil gelatinase associated lipocalin and renal function after percutaneous coronary interventions. Am J Nephrol. 2006;26:87–292.

Venkataraman R, Kellum JA. Defining acute renal failure: the RIFLE criteria. J. Intensive Care Med. 2007;22:187–193.

Royakkers AA, vanSuijlen JD, Hofstra LS. et al. Serum cystatin C — a useful endogenous marker of renal function in intensive care unit patients at risk for or with acute renal failure? Curr Med Chem. 2007;14:2314–2317.

Trof RJ, Di Maggio F, Leemreis J, Groeneveld ABJ. Biomarkers of acute renal injury and renal failure. Shock. 2006;26:245–253.

Dent CL, Ma Q, Dastrala S et al. Plasma neutrophil gelatinase-associated lipocalin predicts acute kidney injury, morbidity and mortality after pediatric cardiac surgery: a prospective uncontrolled cohort study. Crit Care. 2007;11:R127.

Lisowska-Myjak B. Labolatroyjne wskaźniki ostrego uszkodzenia nerek oznaczane w moczu i surowicy. Forum Nefrologiczne. 2010;2(3):71–81.

Han WK, Wagener G, ZhuY. Urinary biomarkers in the early detection of acute kidney injury after cardiac surgery. Clin J Am Soc Nephrol. 2009;4:873.

Zhou H, Hewitt SM, Yuen PS, Star RA. Acute kidney injury biomarkers: Needs, present status, and future promise. NephSAP. 2006;5:63.

Parikh CR et al. Urine Il-18 is an early diagnostic marker for acute kidney injury and predicts mortality in the intensive care unit. J Am Soc Nephrol. 2005;16:3046–3052.

Parikh CR et al. Urine NGAL and Il-18 are predictive biomarkers for delayed graft function following kidney transplantation. Am J Transplant. 2006;6:1639–1645.

Parikh CR et al. Urinary Il-18 is an early predictive biomarker of acute kidney injury after cardiac surgery. Kidney Int. 2006;70:199–203.

Parikh CR et al. Urinary inerleukin-18 is a marker of human acute tubular necrosis. Am J Kidney Dis. 2004;43:405–414.

Portilla D, Dent C, Sugaya T. et al. Liver fatty acid-binding protein as a biomarker of acute kidney injury after cardiac surgery. Kidney Int. 2008;73:465.

Nakamura T, Sugaya T, Node K. et al. Urinary excretion of liver-type fatty acid-binding protein in contrast medium-induced nephropathy. Am J Kidney Dis. 2006;47:439.

Negishi K, Noiri E, Doi K. et al. Monitoring of urinary L-type fatty acid-binding protein predicts histological severity of acute kidney injury. Am J Pathol. 2009;174:1154.

Pelsers MM. Fatty acid-binding protein as marker for renal injury. Scand J Clin Lab Invest Suppl. 2008;241:73.

Jander S, Ledakowicz-Polak A, Jaszewski R, Zielińska M. Ostre uszkodzenie nerek związane z zabiegami kardiochirurgicznymi – współczesne spojrzenie na problem. Kardiochirurgia i Torakochirurgia Polska. 2011;4:457–461.

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Published

2015-03-30

How to Cite

1.
Lipski A, Szymoniak-Lipska M, Greberski K. Acute kidney injury after cardiac surgical operations specially including coronary artery bypass graft operations. JMS [Internet]. 2015 Mar. 30 [cited 2024 Mar. 29];84(1):41-5. Available from: https://jms.ump.edu.pl/index.php/JMS/article/view/34

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Section

Original Papers
Received 2016-02-16
Published 2015-03-30