Incidence of increased creatine kinase and its effect on kidney function in hand assisted laparoscopic kidney donors and their recipients.
OBJECTIVE
Rhabdomyolysis is a rare cause of acute renal failure following laparoscopic donor nephrectomy. The incidence of rhabdomyolysis is not well known and to our knowledge the amount of creatine kinase elevation resulting in renal damage is unknown. We evaluated the incidence of increased creatine kinase, risk factors for increased creatine kinase and its effect on renal function in a series of patients undergoing hand assisted laparoscopic donor nephrectomy.


METHODS
Serum creatine kinase was prospectively measured in 74 consecutive patients who underwent hand assisted laparoscopic donor nephrectomy. These values were measured daily beginning in the recovery room. Demographic and laboratory data, and surgical parameters were analyzed to determine predictors of increased creatine kinase.


RESULTS
Eight of 74 patients (10.8%) had a creatine kinase of 2,500 IU/l or greater and 17 (23%) had a creatine kinase of 1,000 IU/l or greater. Factors associated with a creatine kinase of 2,500 IU/l or greater were operative time (320 vs 275 minutes, p = 0.01) and warm ischemia time (192 vs 138 seconds, p <0.01). Operative time remained an independent risk factor on multivariate analysis (p <0.05). There was no difference in preoperative or postoperative donor creatinine between patients with or without increased creatine kinase, although there was an increased percent change in creatinine in the increased creatine kinase group (80% vs 59%, p = 0.04).


CONCLUSIONS
Creatine kinase elevation occurs in a small but significant number of patients. Operative time was an independent risk factor for increased creatine kinase. Although creatine kinase had no significant effect on short-term creatinine, there was an increase in the percent change in donor creatinine. Finally, the long-term significance of increased creatine kinase without clinical symptoms is unknown.
Harper
Jonathan D
JD
Division of Urology and Transplantation Institute, Loma Linda University Medical Center, Loma Linda, California 92354, USA.
Baron
Pedro W
PW
Ojogho
Okechukwu N
ON
Baldwin
D Duane
DD
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000201:enzymology; D000328:Adult; D003402:Creatine Kinase / Q000097:blood*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000502:physiology*; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000201:enzymology; D011446:Prospective Studies; D012206:Rhabdomyolysis / Q000175:diagnosis* / Q000201:enzymology; D012307:Risk Factors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D052096:Warm Ischemia
D003404:Creatinine; D003402:Creatine Kinase