Renal tubular injury after infrarenal aortic aneurysm repair.
OBJECTIVE
To investigate markers of tubular injury (glutathione-S-transferase [GST] isoforms) as early markers for renal damage in patients undergoing abdominal aortic aneurysm repair.


METHODS
Prospective study.


METHODS
Regional teaching hospital.


METHODS
Eight consecutive patients undergoing elective infrarenal abdominal aortic aneurysm repair.


METHODS
All patients received a standard anesthetic technique including a dopamine infusion (3 microg/kg/min) but without supplemental renoprotective agents. Urine and blood samples were taken at induction, at 1 hour and 3 hours after limb reperfusion, and on days 1 and 2 postoperatively. Urine microalbumin and creatinine concentrations were measured using standard assays, and urine pi-GST and alpha-GST enzyme measurements were performed by a commercial immunoassay (Biotrin, Biotrin International Ltd., Co., Dublin, Ireland).


RESULTS
Five patients (63%) showed a postoperative elevation of serum creatinine (median increase from baseline, 35.4%; range, 8.3% to 50.6%) that was associated with significant elevations of urinary microalbumin-to-creatinine, alpha-GST-to-creatinine, and pi-GST-to-creatinine ratios soon after clamp removal. The remaining 3 patients showed no increase in serum creatinine or urine proteins. Peak alpha-GST-to-creatinine levels were different between the 2 groups. The peak levels of GST enzymes were significantly (r(2) > 80%) associated with the percent increase in serum creatinine from baseline.


CONCLUSIONS
Urinary GST-to-creatinine ratios are a sensitive early biomarker for renal injury after infrarenal abdominal aortic aneurysm repair.
Cressey
Gillian
G
Department of Anaesthetics, Northampton Hospital, United Kingdom.
Roberts
D R Digby
DR
Snowden
Christopher P
CP
D000368:Aged; D000419:Albuminuria; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D015415:Biomarkers / Q000652:urine; D003404:Creatinine / Q000097:blood / Q000652:urine; D005982:Glutathione Transferase / Q000652:urine*; D006801:Humans; D007684:Kidney Tubules / Q000503:physiopathology*; D011183:Postoperative Complications
D015415:Biomarkers; D003404:Creatinine; D005982:Glutathione Transferase