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Acute renal failure (ARF) occurs in up to 30% of patients who undergo cardiac surgery, with dialysis being required in approximately 1% of all patients. The development of ARF is associated with substantial morbidity and mortality independent of all other factors. The pathogenesis of ARF involves multiple pathways. Hemodynamic, inflammatory, and nephrotoxic factors are involved and overlap each other in leading to kidney injury. Clinical studies have identified risk factors for ARF that can be used to determine effectively the risk for ARF in patients who undergo bypass surgery. These high-risk patients then can be targeted for renal protective strategies. Thus far, no single strategy has demonstrated conclusively its ability to prevent renal injury after bypass surgery. Several compounds such as atrial natriuretic peptide and N-acetylcysteine have shown promise, but large-scale trials are needed.Clin -15). ARF that requires dialysis occurs in approximately 1% (1-15). The development of kidney injury is associated with a high mortality, a more complicated hospital course, and a higher risk for infectious complications (1-15). Even minimal changes in serum creatinine that occur in the postoperative period are associated with a substantial decrease in survival (16). Furthermore, the majority of patients who develop ARF that requires dialysis (ARF-D) remain dialysis dependent, leading to significant long-term morbidity and mortality (17). Despite advances in bypass techniques, intensive care, and delivery of hemodialysis, mortality and morbidity associated with ARF have not markedly changed in the last decade (1-15). These data highlight the importance of understanding the pathophysiology of ARF associated with cardiac bypass surgery and implementing specific therapies that are based on this knowledge in well-designed clinical trials. Incidence and Prognosis of ARF after Bypass SurgeryDepending on the definition of ARF, the incidence of ARF varies across studies, with a range of 1 to 30% (1-15). Conlon et al.(1) described a cohort of 2843 patients who underwent cardiopulmonary bypass (CPB) over a 2-yr period. ARF (defined as a rise in serum creatinine Ͼ1 mg/dl above baseline) occurred in 7.9% of patients, and ARF-D occurred in 0.7%. Other studies that used a definition of ARF as a 50% or greater rise in serum creatinine from baseline demonstrated a rate as high as 30% (2-15). Chertow et al. (15) analyzed 42,773 patients who underwent CPB and found an incidence of ARF-D of 1.1%. The incidence of ARF is dependent on the particular type of CPB surgery. Typical coronary artery bypass grafting has the lowest incidence of ARF (approximately 2.5%) and ARF-D (approximately 1%), followed by valvular surgery with an incidence of ARF of 2.8% and ARF-D of 1.7% (18,19). The highest risk group includes combined coronary artery bypass grafting/valvular surgery with an incidence of ARF of 4.6% and ARF-D of 3.3% (18,19) Mortality associated with the development of ARF is as high as 60% in some studies but likely averages 15 to 3...

The murine oct-3 gene encodes a transcription factor containing a POU-specific domain and a homeodomain. In marked contrast to other homeodomain-encoding genes, oct-3 is expressed in the totipotent and pluripotent stem cells of the pregastrulation embryo and is down-regulated during differentiation to endoderm and mesoderm, suggesting that it has a role in early development. The oct-3 gene is also expressed in primordial germ cells and in the female germ line.