Abstract
Introduction. One of the most serious complications after major surgical intervention with longterm
cardiopulmonary bypass (CPB) is the development of acute renal injury (ARI), more often
in the combination of multiorgan failure syndrome. In addition to above mentioned, syndrome
of low emission of ARI, application of nephrotoxic agents (antibiotics, X-ray contrast agents),
reperfusion complications, hemorrhage, concomitant infectious-septic processes take significant
place in etiology of ARI.
Later the beginning of ARI treatment is often explained by untimely diagnostics as the baseline
scores are insufficiently specific and sensitive for early detection of kidney injury that affects on
patients` prognosis with ARI. In literature, the possibility of new laboratory markers of renal
injury is widely discussed, one of them is NGAL (neutrophil gelatinase-associated lipocalin).
In this paper, we analyzed the results of the study of NGAL level in urine (u-NGAL) in patients
after open heart and vessel surgeries under the conditions of long-term cardiopulmonary bypass
in the dynamics of postoperative period.
Material and methods. 48 adult patients and 9 children were examined, who underwent surgical
treatment under the conditions of hypothermia and long-term CPB (more than 120 min.). The
study of u-NGAL, creatinine, urea in blood serum and microalbumin content in urine was made
in three stages: immediately after the surgery, in 2 and 24 hours after the surgery.
Results. In our paper, the rise of u-NGAL in 2 hours after the operation under the conditions of
CPB is distinctly visible and also (p<0.001), the rise of u-NGAL in this period with CPB more
than 150 min. vs the patients with CPB 120-150 min. Hereafter, (in 4, 24 hours) there is a
decrease of u-NGAL concentration. On the contrary, there was the rise of creatinine, urea in
blood serum and microalbumin content in urine of examined patients after cardiosurgical intervention.
Conclusions. Obtained data suggest that introduction of a new marker of renal injury - u-NGAL
into the laboratory practice will provide at the early stages to diagnose and make risk stratification
of ARI in patients after cardiosurgical operations with long-term CPB. To evaluate the reasons
of complication development and also identify the tactics of treatment and monitor the efficacy
of conducting therapy.
References
Bennett M., Dent C. L., Ma Q. et al. Urine NGAL predicts severity of acute kidney injury after cardiac surgery: a prospective study // Clin. J. Am. Soc. Nephrol. 2008. Vol. 3. P. 665-673
Coca S. G., Yalavarthy R., Concato J. et al. Biomarkers for the diagnosis and risk stratification of acute kidney injury: a systematic review // Kidney Int. 2008. Vol. 73. P. 1008-1016.
Devarajan P. Emerging urinary biomarkers in the diagnosis of acute kidney injury // Expert Opin. Med. Diag. 2008. Vol. 2. P. 387-398.
Devarajan P. Neutrophil gelatinase-associated lipocalin-an emerging troponin for kidney injury // Nephrol. Dial. Transplant. 2008. Vol. 23. P. 3737-3743.
Haase M., Bellomo R., Devarajan P. et al. Novel biomarkers early predict the severity of acute kidney injury after cardiac surgery in adults // Ann. Thorac. Surg. 2009. Vol. 88. P. 124-133.
Haase M., Devarajan P., Haase-Fielitz A. et al. The outcome of neutrophil gelatinase-associated lipocalin-positive subclinical acute kidney injury: a multicenter pooled analysis of prospective studies // Am. Coll. Cardiol. 2011. Vol. 57. P. 1752-1761.
Han W. K., Bailly V., Abichandani R. et al. Kidney Injury Molecule-1 (KIM-1): a novel biomarker for human renal proximal tubule injury // Kidney Int. 2002. Vol. 62. P. 237-244.
Han W. K., Waikar S. S., Johnson A. et al. Urinary biomarkers in the early diagnosis of acute kidney injury // Kidney Int. 2008. Vol. 73. P. 863-869.
Kjeldsen L., Johnsen A. H., Sengelov H., Borregaard N. Isolation and primary structure of NGAL, a novel protein associated with human neutrophil gelatinase // J. Biol. Chem. 1993. Vol. 268. P. 10425-10432.
Koyner J. L., Bennett M. R., Worcester E. M. et al. Urinary cystatin C as an early biomarker of acute kidney injury following adult cardiothoracic surgery // Kidney Int. 2008. Vol. 74. P. 1059-1069.
Koyner L., Vaidya V., Bennett M. et al. Urinary biomarkers in the clinical prognosis and early detection of acute kidney injury // Clin. J. Am. Soc. Nephrol. 2010. Vol. 5. P. 2154-2165.
Liangos O., Perianayagam M. C., Vaidya V. S. et al. Urinary N-acetyl-beta-(D)-glucosaminidase activity and kidney injury molecule-1 level are associated with adverse outcomes in acute renal failure // J. Am. Soc. Nephrol. 2007. Vol. 18. P. 904-912.
Mishra J., Dent C., Tarabishi R. et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery // Lancet. 2005. Vol. 365. P. 1231-1238.
Parikh C. R., Abraham E., Ancukiewicz M. et al. Urine IL-18 is an early diagnostic marker for acute kidney injury and predicts mortality in the intensive care unit // J. Am. Sic. Nephrol. 2005. Vol. 16. P. 3046-3052.
Parikh C. R., Jani A., Melnikov V. Y. et al. Urinary interleukin-18 is a marker of human acute tubular necrosis // Am. J. Kidney Dis. 2004. Vol. 43. P. 405-414.
Parikh C. R., Jani A., Mishra J. et al. Urine NGAL and IL-18 are predictive biomarkers for delayed graft function following kidney transplantation // Am. J. Transplant. 2006. Vol. 6. P. 1639-1645.
Wagener G., Gubitosa G., Wang S. et al. A comparison of urinary neutrophil gelatinase-associated lipocalin in patients undergoing on - versus offpump coronary artery bypass graft surgery // J. Cardiothorac. Vasc. Anesth. 2009. Vol. 23. P. 195-199.
Wagener G., Jan M., Kim M. et al. Association between increases in urinary neutrophil gelatinaseassociated lipocalin and acute renal dysfunction after adult cardiac surgery // Anesthesiology. 2006. Vol. 105. P. 485-491.
Yokoyama T., Kamijo-Ikemori A., Sugaya T. et al. Urinary excretion of liver type fatty acid binding protein accurately reflects the degree of tubulointerstitial damage // Am. J. Pathol. 2009. Vol. 174. P. 2096-2106.
