Potentially detrimental effects of N-acetylcysteine on renal function in knee arthroplasty.
Ischaemia/reperfusion induces systemic inflammation and oxidative stress and thereby remote organ injury in the kidney. In a double-blind, placebo-controlled clinical trial of 30 patients undergoing knee arthroplasty with tourniquet, this study evaluated the effect of N-acetylcysteine (NAC) infusion on renal function by measuring urine alpha-1-microglobulin, N-acetyl-beta-D-glucosaminidase (NAG), glutathione-S-transferase-alpha and -phi and serum creatinine and cystatin C concentrations up to 24 h post-operatively. Compared to the baseline, urine alpha-1-microglobulin/creatinine increased in both groups and was higher in the NAC group than in the placebo group at tourniquet deflation and at 3 h thereafter. Urine NAG/creatinine increased at deflation and at 3 h thereafter in the NAC group and the ratio was higher than in the placebo group. The two sensitive indicators of proximal tubular damage and function used in the present study suggest that use of NAC in clinical setting of ischaemia/reperfusion injury may increase the risk of remote kidney injury.
Laisalmi-Kokki
Merja
M
Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland. merja.laisalmi-kokki@kuh.fi
Pesonen
Eero
E
Kokki
Hannu
H
Valta
Päivi
P
Pitkänen
Mikko
M
Teppo
Anna-Maija
AM
Honkanen
Eero
E
Lindgren
Leena
L
D000111:Acetylcysteine / Q000009:adverse effects*; D000118:Acetylglucosaminidase / Q000652:urine; D000368:Aged; D000510:Alpha-Globulins / Q000652:urine; D019645:Arthroplasty, Replacement, Knee; D003404:Creatinine / Q000097:blood / Q000652:urine; D055316:Cystatin C / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D016166:Free Radical Scavengers / Q000009:adverse effects*; D051549:Glutathione S-Transferase pi / Q000652:urine; D005982:Glutathione Transferase / Q000652:urine; D006801:Humans; D007275:Injections, Intravenous; D007527:Isoenzymes / Q000652:urine; D007674:Kidney Diseases / Q000139:chemically induced*; D007677:Kidney Function Tests; D007687:Kidney Tubules, Proximal / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D000510:Alpha-Globulins; D055316:Cystatin C; D016166:Free Radical Scavengers; D007527:Isoenzymes; C016001:alpha-1-microglobulin; D003404:Creatinine; D051549:Glutathione S-Transferase pi; D005982:Glutathione Transferase; C119995:glutathione S-transferase alpha; D000118:Acetylglucosaminidase; D000111:Acetylcysteine