Surgery with and without extracorporeal circulation in patients aged above 65 and kidney injury assessed by NGAL concentration

Abstract

Operacje w krążeniu pozaustrojowym i bez krążenia pozaustrojowego u chorych powyżej 65. roku życia a uszkodzenie nerek oceniane na podstawie stężenia NGAL A An ne et tt ta a K Ko ow wa al lc cz zu uk k--W Wi ie et te es sk ka a, , M Ma ar rt ta a S Sz ze ew wc cz zy yk k, , S Sa an nd dr ra a L Li in nd do on n, , M Ma ar ri ia an n Z Ze em mb ba al la a A Ai im m: : The aim of the work was to determine whether NGAL is a sensitive predictive index of AKI in elderly patients (> 65 years old) undergoing cardiac surgery, with and without extracorporeal circulation.M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : The study group encompassed 30 patients aged > 65 years, treated surgically, 18 with extracorporeal circulation (group I) and 12 without (group II). The serum concentrations of NGAL, cystatin C and the serum glomerular filtration rate (GFR) were assessed 24 h before surgery, and then 2 h and 24 h after surgery. The tests were carried out using immunochemical, nephelometric and standard clinical biochemical methods.R Re es su ul lt ts s: : In both groups, pre-operative cardiac, pulmonary and renal functions were normal. Hypertension was successfully treated in 16 patients, diabetes type 2 with normal baseline NGAL and no signs of nephropathy in 4 patients. In group I, the pre-operative levels of NGAL, cystatin C and GFR were normal. Two hours after surgery, there was a statistically significant increase in the level of NGAL, whilst GFR and cystatin C remained unchanged. Twenty-four hours after surgery, NGAL decreased slightly but was still statistically significantly higher than the baseline value. In group II, by contrast, there were no significant differences between preand post-operative levels of NGAL, cystatin C and GFR.C Co on nc cl lu us si io on ns s: : Neutrophil gelatinase-associated lipocalin is the most sensitive biomarker of transient renal ischemia related to the use of extracorporeal circulation in elderly patients with normal pre-and post-operative renal function. In elderly patients with normal renal function before and after cardiac surgery without extracorporeal circulation, NGAL levels are normal. K Ke ey y w wo or rd ds s: : neutrophil gelatinase-associated lipocalin (NGAL), renal diseases, cardiac surgery, elderly patients S t r e s z c z e n i e W Ws st tę ęp p: : Lipokalina związana z żelatynazą neutrofilów (human neutrophil gelatinase associated lipocalin -NGAL) jest jednym z najczulszych wskaźników predykcyjnych ostrej niewydolności nerek.C Ce el l: : Ustalenie, czy u chorych powyżej 65. roku życia poddanych operacjom kardiochirurgicznym zarówno przy użyciu, jak i bez krążenia pozaustrojowego NGAL jest czułym wskaźnikiem predykcyjnym zagrażającej ostrej niewydolności nerek.M Ma at te er ri ia ał ł i i m me et to od dy y: : Grupę badaną stanowili chorzy powyżej 65 lat leczeni operacyjnie z zastosowaniem krążenia pozaustrojowego (n = 18) oraz bez jego zastosowania (off pump coronary artery bypass -OPCAB) (n = 12). Stężenie NGAL, cystatyny C i współczynnik przesączania kłębu...