title: Renal tubular injury after infrarenal aortic aneurysm repair.
abstract: 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.
authors.affiliation: Department of Anaesthetics, Northampton Hospital, United Kingdom.
authors.forename: Gillian
authors.initials: G
authors.lastname: Cressey
authors.forename: D R Digby
authors.initials: DR
authors.lastname: Roberts
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Snowden
mesh_terms: 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
chemical_list: D015415:Biomarkers; D003404:Creatinine; D005982:Glutathione Transferase