Cardiac Surgery–Associated Kidney Injury in Children and Renal Oximetry

Joffe, Rachel; Aklabi, Mohammed Al; Bhattacharya, Shantanu; Cave, Dominic; Calleja, Thomas; Garros, Daniel; Majesic, Nicholas; Ryerson, Lindsay; Morgan, Catherine

doi:10.1097/pcc.0000000000001656

Cited by 32 publications

(19 citation statements)

References 33 publications

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“…In a recently published trial, serum creatinine concentrations were used to define AKI according to the pRIFLE criteria in children undergoing cardiac surgery with cardiopulmonary bypass. As in our study, when comparing rSrO 2 with the development of renal failure, they also detected an increased rSrO 2 in the children who presented with postoperative renal failure [7]. In children undergoing kidney transplantation, postoperative renal rSrO 2 assessed by NIRS strongly correlates with common markers of kidney graft function and perfusion, allowing continuous real-time monitoring of blood flow in renal grafts by NIRS [25].…”

Section: E919717-7supporting

confidence: 81%

“…Near-infrared spectroscopy (NIRS) technology uses an infrared light source to measure regional oxyhemoglobin (SrO 2 ) saturation non-invasively, continuously, and in real-time [2].Several studies have been published on infants and children who underwent cardiac surgery with cardiopulmonary bypass, showing that changes in renal SrO 2 (rSrO 2 ) are significantly correlated with development of postoperative AKI [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Acute Kidney Injury and Renal Regional Oxygen Saturation During Pediatric Liver Transplantation

et al. 2020

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Departmental sources Background:Kidney injury is a complication among children undergoing liver transplantation (pLTx). Cystatin C serum concentration seems to be superior to creatinine-based determination of kidney injury in adults and children. Nearinfrared spectroscopy (NIRS) technology provides non-invasive and real-time measurement of renal tissue oxygenation. Here, we compared renal tissue oximetry (rSrO 2 ) with conventional diagnostic criteria cystatin C and creatinine concentration in children undergoing pLTx. Material/Methods: rSrO 2 was measured intraoperatively in children undergoing pLTx over the left kidney, and was statistically compared with pre-and postoperative serum creatinine and cystatin C concentrations. Results:rSrO 2 was affected by hemoglobin concentration, bilirubin concentration, and FiO 2 . Statistical analysis demonstrated that rSrO 2 was significantly reduced in children with preoperative pathologic increased cystatin C concentrations compared to children without (63.7±4.3 vs. 53.4±4.9, p<0.05). We did not detect a significant difference in rSrO 2 between children who developed postoperative renal impairment, either determined by increased postoperative cystatin C concentration, creatinine concentration, or the pRIFLE criteria. Intraoperative increase or decrease in rSrO 2 did not predict the development of postoperative kidney injury. Conclusions:In children with liver failure undergoing pLTx, a preoperative decrease in rSrO 2 indicates compromised renal function. However, intraoperative rSrO 2 is not predictive of postoperative kidney injury.

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Section: E919717-7supporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Acute Kidney Injury and Renal Regional Oxygen Saturation During Pediatric Liver Transplantation

et al. 2020

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“…Perhaps, we need to move beyond the historical and arguably simplistic view of maximizing oxygen delivery and minimizing oxygen consumption to prevent AKI [18, 46, 47]. Multiple lines of evidence suggest that mitochondria of the PT represent one of the most important initial pathogenic sites of injury in AKI, and hence also a promising therapeutic target in ameliorating AKI as well as reducing the long-term adverse sequelae of AKI [16, 48].…”

Section: Targeting Mitochondria Of the Proximal Tubules In Akimentioning

confidence: 99%

The Proximal Tubule as the Pathogenic and Therapeutic Target in Acute Kidney Injury

Morgan

2022

Nephron

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Background: In 2004, the term acute kidney injury (AKI) was introduced with the intention of broadening our understanding of rapid declines in renal function and to replace the historical terms of acute renal failure and acute tubular necrosis (ATN). Despite this evolution in terminology, the mechanisms of AKI have stayed largely elusive with the pathophysiological concepts of ATN remaining the mainstay in our understanding of AKI. Summary: The proximal tubule (PT), having the highest mitochondrial content in the kidney and relying heavily on oxidative phosphorylation to generate ATP, is vulnerable to ischaemic insults and mitochondrial dysfunction. Histologically, pathological changes in the PT are more consistent than changes to the glomeruli or the loop of Henle in AKI. Physiologically, activation of tubuloglomerular feedback due to PT dysfunction leads to an increase in preglomerular afferent arteriole resistance and a reduction in glomerular filtration. Pharmacologically, frusemide – a drug commonly used in the setting of oliguric AKI – is actively secreted by the PT and its diuretic effect is compromised by its failure to be secreted into the urine and thus be delivered to its site of action at the loop of Henle in AKI. Increases in the urinary, but not plasma biomarkers, of PT injury within 1 h of shock suggest that the PT as the initiation pathogenic target of AKI. Key Message: Therapeutic agents targeting specifically the PT epithelial cells, in particular its mitochondria – including amino acid ergothioneine and superoxide scavenger MitoTEMPO – show great promises in ameliorating AKI.

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“…1 Still, in the (early) postoperative phase following CCS, mortality remains increased. 1,2 Especially in the perioperative phase, CCS procedures can be complicated by organ injury 3 such as acute kidney injury, 4 and adverse neurologic events such as seizures and strokes. 5 The development of such complications can prolong treatment in the intensive care unit (ICU), including protracted duration of mechanical ventilation (MV), and can lead to longer hospitalization, which is associated with increased morbidity and mortality, [1][2][3]6 along with higher costs.…”

Section: Résumémentioning

confidence: 99%

Cerebral oxygenation during pediatric congenital cardiac surgery and its association with outcome: a retrospective observational study

Modestini

Hoffmann

Niezen

et al. 2020

Can J Anesth/J Can Anesth

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Purpose Non-invasive cerebral oxygen saturation (ScO 2 ) monitoring is an established tool in the intraoperative phase of pediatric congenital cardiac surgery (CCS). This study investigated the association between ScO 2 and postoperative outcome by investigating both baseline ScO 2 values and intraoperative desaturations from baseline. Methods All CCS procedures performed in the period 2010-2017 in our institution in which ScO 2 was monitored were included in this historical cohort study. Baseline ScO 2 was determined after tracheal intubation, before surgical incision. Subgroups were based on cardiac pathology and degree of intracardiac shunting. Poor outcome was defined based on length of stay (LOS) in the intensive care unit (ICU)/hospital, duration of mechanical ventilation (MV),

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Cardiac Surgery–Associated Kidney Injury in Children and Renal Oximetry

Cited by 32 publications

References 33 publications

Acute Kidney Injury and Renal Regional Oxygen Saturation During Pediatric Liver Transplantation

Acute Kidney Injury and Renal Regional Oxygen Saturation During Pediatric Liver Transplantation

The Proximal Tubule as the Pathogenic and Therapeutic Target in Acute Kidney Injury

Cerebral oxygenation during pediatric congenital cardiac surgery and its association with outcome: a retrospective observational study

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