Neutrophil Gelatinase Associated Lipocalin as a Biomarker for Acute Kidney Injury in Patients Undergoing Coronary Artery Bypass Grafting with Cardiopulmonary Bypass

Prabhu, A.; Sujatha, D.; Ninan, Benjamin; Vijayalakshmi, M. A.

doi:10.1016/j.avsg.2010.01.001

Cited by 56 publications

(33 citation statements)

References 31 publications

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“…Among these, the most frequently studied and most important biomarker is NGAL (16,17). Munir et al (7) in their study found that while serum creatinine levels were increased at 24-48 hours after surgery, urine NGAL concentrations showed a significant increase at postoperative 4 hours.…”

Section: Discussionmentioning

confidence: 99%

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Rapid Detection of Acute Kidney Injury by Urinary Neutrophil Gelatinase-Associated Lipocalin in Patients Undergoing Cardiopulmonary Bypass

Bayram¹,

Ezelsoy²,

Usta³

et al. 2014

Turk J Anesth Reanim

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Objective: Acute kidney injury (AKI) is common following cardiopulmonary bypass (CPB). The aim of this study is to determine the accuracy of urinary neutrophil gelatinase-associated lipocalin (NGAL) levels following cardiac surgery to establish the severity of renal impairment as compared to serum creatinine levels.Methods: A total number of 28 patients undergoing elective cardiopulmonary bypass were included. Diagnostic criteria of AKI was established in case of a percentage increase in serum creatinine concentration of >50%. Serum creatinine levels were recorded in the preoperative period before induction and in the postoperative period at 24, 48, and 72 hours. Urinary NGAL measurement was performed before induction and in the 4 th postoperative hour. The duration of CPB surgery, hospital stay, and cross-clamp time were recorded.Results: Based on AKI criteria, subjects were grouped as AKI (n=11) and no AKI (n=19). Postoperative urinary NGAL levels were significantly higher in the group with AKI (11.8 ng mL -1 vs. 104.0 ng mL -1 , p=0.003). In the AKI group, CPB time bypass (111.9 min vs. 82.7 min) and cross-clamp time (76.9 min vs. 59.1 min) were significantly higher. A cut-off of 25.5 ng mL -1 yielded a sensitivity of 81.82% and a specificity of 94.12% at the postoperative 4 th hour with an AUC of 0.947 for predication of AKI. Conclusion:Urine NGAL rose significantly much earlier as compared to serum creatinine levels in the early postoperative period. Although larger case series are needed, we are of the opinion that urinary NGAL measurements may be used as an early clinical marker of AKI following CPB.Key Words: Acute kidney injury, neutrophil gelatinase-associated lipocalin, cardiopulmonary bypass Abstract Introduction

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Section: Discussionmentioning

confidence: 99%

“…In recent years, various biomarkers have been studied to detect tubular injury in the early period with a good specificity and sensitivity (16,17). IL-18, Cystatin C, NGAL and Kidney Injury Molecule-1 are among these biomarkers.…”

Section: Discussionmentioning

confidence: 99%

Rapid Detection of Acute Kidney Injury by Urinary Neutrophil Gelatinase-Associated Lipocalin in Patients Undergoing Cardiopulmonary Bypass

Bayram¹,

Ezelsoy²,

Usta³

et al. 2014

Turk J Anesth Reanim

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“…Therefore, we determined that 49 patients were required in each group to detect a 50% reduction in the incidence of AKI between the groups to obtain a power of 80%, considering a type I error of 0.05. Regarding the measurement of NGAL, we determined that 18 patients were required in each group to detect a mean difference of 50 ng/ml (SD of 50 ng/ml) to obtain a power of 80%, considering a type I error of 0.05 [15,16]. …”

Section: Methodsmentioning

confidence: 99%

Effect of erythropoietin on the incidence of acute kidney injury following complex valvular heart surgery: a double blind, randomized clinical trial of efficacy and safety

et al. 2013

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IntroductionRecombinant human erythropoietin (EPO) is known to provide organ protection against ischemia-reperfusion injury through its pleiotropic properties. The aim of this single-site, randomized, case-controlled, and double-blind study was to investigate the effect of pre-emptive EPO administration on the incidence of postoperative acute kidney injury (AKI) in patients with risk factors for AKI undergoing complex valvular heart surgery.MethodsWe studied ninety-eight patients with preoperative risk factors for AKI. The patients were randomly allocated to either the EPO group (n = 49) or the control group (n = 49). The EPO group received 300 IU/kg of EPO intravenously after anesthetic induction. The control group received an equivalent volume of normal saline. AKI was defined as an increase in serum creatinine >0.3 mg/dl or >50% from baseline. Biomarkers of renal injury were serially measured until five days postoperatively.ResultsPatient characteristics and operative data, including the duration of cardiopulmonary bypass, were similar between the two groups. Incidence of postoperative AKI (32.7% versus 34.7%, P = 0.831) and biomarkers of renal injury including cystatin C and neutrophil gelatinase-associated lipocalin showed no significant differences between the groups. The postoperative increase in interleukin-6 and myeloperoxidase was similar between the groups. None of the patients developed adverse complications related to EPO administration, including thromboembolic events, throughout the study period.ConclusionsIntravenous administration of 300 IU/kg of EPO did not provide renal protection in patients who are at increased risk of developing AKI after undergoing complex valvular heart surgery.Trial registrationClinical Trial.gov, NCT01758861

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“…Cellular mechanisms that promote reperfusion injury are incompletely understood [16,17]. Ischemia-reperfusion injury induces several histopathological changes and a cascade leading to tissue injury.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Serum Myocardial Biomarkers Following Two Different Methods of Venoaortic Connection in Coronary Artery Bypass Grafting: A Randomized Clinical Trial

Jelodar

Zarrabi

Nazifi

et al. 2017

Zahedan J Res Med Sci

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Background: Myocardium will expose to excessive ischemia and reperfusion during post-cardiac surgery, hence the aim of this study was to investigate the cardioprotective effect of sequential partial aortic side biting technique for proximal veno-aortic anastomosis constructions in patients undergoing coronary artery bypass grafting (CABG). Methods: In this randomized clinical trial study, 60 consecutive patients who were diagnosed to suffering from triple vessel coronary artery diseases were selected. CABG patients were assigned randomly into two groups; the first group received sooner and gradual myocardial reperfusion one-by-one top end venous anastomosis to the aorta (sequential aortic side biting technique) (n = 30) and the second group undergo proximal anastomoses constructed during a single period of aortic side biting (single aortic side biting technique) (n = 30). The serum levels of myocardial damage biomarkers including creatine phosphokinase-MB (CPK-MB), Troponin I, glutathione peroxidase (GPX), superoxide dismutase (SOD), malondialdehyde (MDA) and catalase (CAT) were measured preoperatively, postoperatively and 24 h after operation. Independent t-tests was used to compare results between groups. Results: The level of all myocardial biomarkers increased after the operation. Those in study group had significantly lower levels of troponin I (P < 0.001), CPK-MB (P = 0.001), GPX (P = 0.007), SOD (P = 0.005), and CAT (P = 0.015), 24h after the operation when compared to control group. Only the serum level of CPK-MB was significantly lower in study group after the operation (P = 0.029) while the other markers were comparable. Conclusions: Sequential partial occluding aortic side biting technique associated with less myocardial damage and ischemiareperfusion injury compared to conventional single method in patients undergoing elective coronary grafting.

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Neutrophil Gelatinase Associated Lipocalin as a Biomarker for Acute Kidney Injury in Patients Undergoing Coronary Artery Bypass Grafting with Cardiopulmonary Bypass

Cited by 56 publications

References 31 publications

Rapid Detection of Acute Kidney Injury by Urinary Neutrophil Gelatinase-Associated Lipocalin in Patients Undergoing Cardiopulmonary Bypass

Rapid Detection of Acute Kidney Injury by Urinary Neutrophil Gelatinase-Associated Lipocalin in Patients Undergoing Cardiopulmonary Bypass

Effect of erythropoietin on the incidence of acute kidney injury following complex valvular heart surgery: a double blind, randomized clinical trial of efficacy and safety

Comparison of Serum Myocardial Biomarkers Following Two Different Methods of Venoaortic Connection in Coronary Artery Bypass Grafting: A Randomized Clinical Trial

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