Glomerular permeability after surgical trauma in children: relationship between microalbuminuria and surgical stress score.
OBJECTIVE
To determine whether there is an increase of urinary albumin during and after surgical trauma and investigate a possible relationship between microalbuminuria and the severity of surgical stress.


METHODS
Prospective study.


METHODS
University hospital pediatric intensive care unit.


METHODS
Forty consecutive children scheduled for elective surgery.


METHODS
None.


RESULTS
Microalbuminuria/urinary creatinine ratio (MACR) was measured before, during, and after elective moderate or major surgical procedures. The Oxford Surgical Stress Score (SSS) was determined for each patient at the end of the operation, and its relationship with maximum deviation of MACR from baseline values was investigated. MACR showed a progressive increase during surgery and a decrease afterward, reaching preoperative values in most cases within 24 hrs after the end of surgery. There was a significant correlation between the increase in MACR and severity of the surgical trauma as measured by SSS. Two patients showed a rise in MACR after the initial postoperative normalization before clinical appearance of a surgical complication and one patient showed a persistent rise in MACR before clinical appearance of a septic complication. None of the other patients showed any rise in MACR after postoperative normalization, and they all had an uneventful recovery.


CONCLUSIONS
MACR rises during and after major or moderate elective surgery in children. There is a significant positive correlation between severity of surgical trauma and capillary permeability in pediatric patients. Microalbuminuria, as an index of capillary permeability, may be an early sign of incipient complications and assist in the identification of those patients whose condition will deteriorate. The test is a cheap, blood-sparing, easy-to-perform bedside procedure that may have a useful role in clinical practice for evaluating the effect of surgical trauma on capillary permeability in children.
Sarti
A
A
Department of Anesthesia and Intensive Care, Research and Care Children Hospital, IRCCS Burlo Garofolo, via dell'Istria 65/1, 34 137 Trieste, Italy. sarti@burlo.trieste.it
De Gaudio
A R
AR
Messineo
A
A
Cuttini
M
M
Ventura
A
A
D000419:Albuminuria / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000652:urine; D003422:Critical Care; D005260:Female; D006801:Humans; D007223:Infant; D007678:Kidney Glomerulus / Q000378:metabolism; D016014:Linear Models; D008297:Male; D011183:Postoperative Complications / Q000652:urine*; D011446:Prospective Studies
D003404:Creatinine