Non-invasive measurement of renal perfusion and oxygen metabolism to predict postoperative acute kidney injury in neonates and infants after cardiopulmonary bypass surgery

Neunhoeffer, Felix; Wiest, Milena; Sandner, Katharina; Renk, Hanna; Heimberg, Ellen; Haller, Christoph; Kumpf, Matthias; Schlensak, Christian; Hofbeck, Michael

doi:10.1093/bja/aew307

Cited by 22 publications

(23 citation statements)

References 51 publications

(77 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Near-infrared spectroscopy allows for the continuous assessment of regional tissue oxygenation (rSO 2 ), and is believed to reflect renal rSO 2 when placed on the flank overlying the kidney. While some studies have observed an association between prolonged periods low perioperative renal rSO 2 and AKI after congenital cardiac surgery (9–11), other studies have failed to show an association (12, 13). Interestingly, although the study by Hazle, et al did not find an association between prolonged low renal rSO 2 and creatinine-based AKI after infant cardiac surgery, they did observe an association between renal rSO 2 and higher postoperative NGAL and interleukin-18 levels, suggesting an association between renal rSO 2 and kidney injury by more novel indicators (13).…”

Section: Introductionmentioning

confidence: 99%

Associations of Perioperative Renal Oximetry Via Near-Infrared Spectroscopy, Urinary Biomarkers, and Postoperative Acute Kidney Injury in Infants After Congenital Heart Surgery: Should Creatinine Continue to Be the Gold Standard?

Adams

Vargas

Baust

et al. 2019

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

Objective: Examine the relationship between perioperative renal regional oximetry (rSO2), urinary biomarkers, and acute kidney injury (AKI) in infants after congenital cardiac surgery with cardiopulmonary bypass. Design: Prospective, observational. Setting: Cardiac operating room and intensive care unit (CICU) Patients: Neonates and infants without history of kidney injury or anatomic renal abnormality. Interventions: None. Measurements and Main Results: Renal rSO2 was measured intraoperatively and for 48 hours postoperatively. Urinary levels of neutrophil gelatinase-associated lipocalin (NGAL) and tissue inhibitor of metalloproteinases 2 (TIMP-2) together with insulin-like growth factor-binding protein 7 (IGFBP7) were measured preoperatively, 2, 12, and 24 hours postoperatively. Patients were categorized as no AKI, Stage 1, or Stage 2–3 AKI using KDIGO criteria with 43/70 (61%) meeting criteria for any stage AKI. Stage 2–3 AKI patients had higher [TIMP-2]•[IGFBP7] at 2 hours (0.3 vs. 0.14 for Stage 1 AKI and 0.05 for no AKI, P=0.052) and 24 hours postop (1.71 vs. 0.27 for Stage 1 AKI and 0.19 for no AKI, P=0.027) and higher NGAL levels at 24 hours postop (10.3 vs. 3.4 for Stage 1 AKI and 6.2 for no AKI, P=0.019). Stage 2–3 AKI patients had lower mean CICU renal rSO2 (66% vs. 79% for Stage 1 AKI and 84% for no AKI, P=0.038). Regression analyses showed that [TIMP-2]•[IGFBP7] at 2 hours postop and nadir intraoperative renal rSO2 to be independent predictors of postoperative kidney damage as measured by urinary NGAL. Conclusions: We observed modest differences in perioperative renal rSO2 and urinary biomarker levels compared between AKI groups classified by creatinine-dependent KDIGO criteria, but there were significant correlations between renal rSO2, [TIMP-2]•[IGFBP7], and postoperative NGAL levels. Kidney injury after infant cardiac surgery may be undetectable by functional assessment (creatinine) alone and continuous monitoring of renal rSO2 may be more sensitive to important subclinical AKI.

show abstract

Section: Introductionmentioning

confidence: 99%

Associations of Perioperative Renal Oximetry Via Near-Infrared Spectroscopy, Urinary Biomarkers, and Postoperative Acute Kidney Injury in Infants After Congenital Heart Surgery: Should Creatinine Continue to Be the Gold Standard?

Adams

Vargas

Baust

et al. 2019

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…Further, clinical management of AKI in preterm infants is challenging and often ineffective due to therapeutic limitations to renal replacement therapy (ie, dialysis) in this population; therefore, early recognition and prevention may enhance the efficacy of current therapeutic approaches or limit additive injury from pathologic or iatrogenic sources 12. Continuous renal NIRS monitoring may provide an early warning indicator for potential or actual renal hypoperfusion, which is supported by recent studies 9–11,15–22…”

mentioning

confidence: 87%

Renal Oxygenation (rSO2) Population Parameter Estimates in Premature Infants Routinely Monitored With Near-Infrared Spectroscopy

Marin

Williams

Mansuri

et al. 2021

Advances in Neonatal Care

View full text Add to dashboard Cite

ear-infrared spectroscopy (NIRS) technology serves as a surrogate marker for tissue bed oxygenation and is useful for determining "real-time" oxygen extraction (eg, utilization) in a variety of tissues including the brain, kidneys, and abdominal viscera. 1,2 Regional tissue oxygenation (rSO 2 ) values are calculated as the difference between oxygenated and deoxygenated hemoglobin measured by chromophore absorption of infrared light in nonpulsatile vascular beds. 1 Oxygen contribution within these compartments is estimated as 75% venous, 20% arterial, and 5% capillary; therefore,

show abstract

“…However, NIR technology is not used during cardiac surgery for the monitoring of kidney function in clinical practice, yet it could serve as a possible solution for the earlier detection of CSA-AKI [ 45 , 46 , 61 ]. In multiple studies [ 50 , 55 , 58 , 61 , 62 , 63 ], CSA-AKI has been linked to lower renal rSO 2 values both intra-operatively (i.o.) and during the first 48 h postoperatively (p.o.)…”

Section: Kidney Diseasesmentioning

confidence: 99%

The Potential Use of Near- and Mid-Infrared Spectroscopy in Kidney Diseases

Delrue

Bruyne

Speeckaert

2023

IJMS

View full text Add to dashboard Cite

Traditional renal biomarkers such as serum creatinine and albuminuria/proteinuria are rather insensitive since they change later in the course of the disease. In order to determine the extent and type of kidney injury, as well as to administer the proper therapy and enhance patient management, new techniques for the detection of deterioration of the kidney function are urgently needed. Infrared spectroscopy is a label-free and non-destructive technique having the potential to be a vital tool for quick and inexpensive routine clinical diagnosis of kidney disorders. The aim of this review is to provide an overview of near- and mid-infrared spectroscopy applications in patients with acute kidney injury and chronic kidney disease (e.g., diabetic nephropathy and glomerulonephritis).

show abstract

Non-invasive measurement of renal perfusion and oxygen metabolism to predict postoperative acute kidney injury in neonates and infants after cardiopulmonary bypass surgery

Abstract: Monitoring of renal oxygen metabolism allows early prediction of AKI in infants after cardiac surgery. In contrast, renal resistive index does not allow prediction of AKI after neonatal palliation with aortopulmonary shunt establishment.

Cited by 22 publications

References 51 publications

Associations of Perioperative Renal Oximetry Via Near-Infrared Spectroscopy, Urinary Biomarkers, and Postoperative Acute Kidney Injury in Infants After Congenital Heart Surgery: Should Creatinine Continue to Be the Gold Standard?

Associations of Perioperative Renal Oximetry Via Near-Infrared Spectroscopy, Urinary Biomarkers, and Postoperative Acute Kidney Injury in Infants After Congenital Heart Surgery: Should Creatinine Continue to Be the Gold Standard?

Renal Oxygenation (rSO2) Population Parameter Estimates in Premature Infants Routinely Monitored With Near-Infrared Spectroscopy

The Potential Use of Near- and Mid-Infrared Spectroscopy in Kidney Diseases

Contact Info

Product

Resources

About