Neutrophil gelatinase-associated lipocalin levels after use of mini-cardiopulmonary bypass system

Abstract

Neutrophil gelatinase-associated lipocalin (NGAL) has been implicated as an early predictive urinary biomarker of ischemic acute kidney injury (AKI). The aim of this study was to compare the effects of miniaturized cardiopulmonary bypass system (MCPB) vs. standard cardiopulmonary bypass system (SCPB) system on kidney tissue in patients undergoing myocardial revascularization using urinary NGAL levels as an early marker for renal injury. Sixty consecutive patients who underwent myocardial revascularization were studied prospectively. An SCPB was used in 30 patients (group A) and MCPB was used in 30 patients (group B). The SCPB group but not the MCPB group showed a significant NGAL concentration increase from preoperative during the 1st postoperative day (169.0+/-163.6 ng/ml in the SCPB group vs. 94.1+/-99.4 ng/ml in the MCPB group, P<0.05, respectively). Two patients in the SCPB group developed AKI and underwent renal replacement therapy; no patient in MCPB developed AKI. The MCPB system is safe in routine clinical use. Kidney function is better protected during MCPB as demonstrated by NGAL levels. NGAL represents an early biomarker of renal failure in patients undergoing cardiac surgery and the valuation of its concentration can aid in medical decision-making.

α–Intercalated cells defend the urinary system from bacterial infection

“…8,9), and its protein appeared in the urine and in the serum (5-to 500-fold increase) within hours of stimuli that typically cause acute kidney injury (AKI). Inductive stimuli included sepsis (10)(11)(12)(13)(14), ischemia-reperfusion injury (IR) (9,(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27), obstructive uropathy (28), nephrotoxins (15,(29)(30)(31)(32)(33), traumarhabdomyolysis (34), kidney graft injury (35,36), or a mixture of these maladies (37,38). Sepsis was a particularly strong stimulus for LCN2 expression.…”

Neutrophil Gelatinase Associated Lipocalin in Acute Kidney Injury

“…Of the 339 articles, 160 were unique articles that were eligible for review based on the predefined criteria for inclusion in our review (Table 1). A total of 56 studies were related to NGAL and acute kidney injury OR AKI 8,9,12,14,17,19, ; 31 related to NGAL and cardiac surgery 7,16,19,31,33,35,45,[47][48][49][50][51]54,55,57,58,62,64,[74][75][76][77][78][79][80][81][82][83][84][85][86] ; 8 related to NGAL and cardiology or heart failure 9,52,61,[87][88][89][90][91] ; 18 related to NGAL and intensive care 14,28,29,[36][...…”

“…The results of our search of the literature identified 56 clinical trials investigating the role of patient NGAL level as an early biomarker in the detection of AKI. 8,9,12,14,17,19,112 Neutrophil gelatinase-associated lipocalin has been shown to be an early marker of AKI in a wide spectrum of clinical conditions, 12,[24][25][26][27][28][29][30]66,67,112 including postcardiac catheterization, 31 cardiac surgery, and cardiopulmonary bypass (CPB) 17,19,33,35,45,47,50,51,54,55,57,58,60,62,64,70,71 ; coronary artery disease (CAD) 52,61 ; heart failure 9,52 ; treatment in an intensive care unit (ICU) 38,42,46 ; in trauma patients 8,14,68 ; patients with toxic AKI and CIN 17,31,36,39,60,63 ; CKD 32,53,56,59 ; renal allograft and transplantation 36,44,53 ; post liver transplantation 40,106,110 ; and post heart and lung transplantation. 33,41,74 Moreover, patient NGAL level has been shown to be an early predictor of clinical outcomes in AKI, 12,25,…”

Comparative Efficiency of Plasma NGAL (Neutrophil Gelatinase-Associated Lipocalin) in Off-pump and On-pump Cardiac Surgery in the Early Dıagnosis of Acute Renal Injury

“…(9) mini-kardiopulmoner baypas sistemi kullanılan hastalar ile standart KPB yönte-mi ile yapılan hastalarda pNGAL düzeyi bakılmış ve pNGAL seviyesi ile mini-KPB sisteminin renal fonksiyonları daha iyi koruduğunu göstermişlerdir.…”