[A study of glomerular damage due to extracorporeal circulation--meaning and usefulness of measuring of urinary microalbumin].
An increase of excretion of urinary microalbumin (U-Alb) is thought to demonstrate earlier glomerular damage than deterioration of Glomerular Filtration Rate (GFR). In this study, the meaning and usefulness of measuring U-Alb before, during and after Extracorporeal Circulation (ECC) was estimated. In 25 cases of adult cardiac surgery, we measured U-Alb, and simultaneously as current indices of glomerular function, serum and urinary creatinine, blood urea nitrogen, serum beta 2-microglobulin, urine volume, and cardiac output were measured. Albumin Excretion Rate (AER) [U-Alb X urine volume] and Albumin Index (AlbI) [U-Alb/U-Cr] were calculated as indices of U-Alb, and Creatinine clearance (Ccr) was calculated as GFR. The changes of each parameter, the correlation AER and AlbI during and after ECC with parameters that relate to ECC, and the assessment of the prolongation of glomerular damage after operation that possibly progress to acute renal failure were investigated. Our results showed AER and AlbI to increase following ECC with high values maintained during and after ECC, in spite of recovery of Ccr, from 24 hours to 4 days postoperatively. AER and AlbI recovered at 7 days and 14 days after surgery, respectively. The existence of glomerular damage, not indicated by a change in Ccr, was indicated by increases of AER and AlbI. The damage was thought to be temporary glomerular dysfunction. In correlation of AER and AlbI with ECC parameters, ECC of long duration influenced the glomerular damage as indicated by an increase of AER and AlbI.(ABSTRACT TRUNCATED AT 250 WORDS)
Aiba
M
M
Department of Surgery, School of Medicine, Showa University, Tokyo, Japan.
Murakami
A
A
Funami
M
M
Takaba
T
T
D000328:Adult; D000368:Aged; D000418:Albumins / Q000378:metabolism*; D000419:Albuminuria / Q000652:urine*; D005112:Extracorporeal Circulation / Q000009:adverse effects*; D005260:Female; D006349:Heart Valve Diseases / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology; D007678:Kidney Glomerulus / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests
D000418:Albumins