Acute kidney injury after abdominal aortic aneurysm surgery: detailed assessment of early effects using novel markers.
BACKGROUND
One of the most severe complications of repair surgery for abdominal aortic aneurysms (AAA) is acute kidney injury (AKI). Even small rises in serum creatinine after surgery are associated with increased mortality.


OBJECTIVE
The aim of the study was to assess the dynamics of AKI after elective AAA surgery using novel markers.


METHODS
The study group consisted of 14 patients with AAA. We measured serum neutrophil gelatinase‑associated lipocalin (NGAL) before, during (including intra‑abdominal vein levels before and after removal of aortic clamp), and within 2 days after surgery.  Moreover, we assessed urinary NGAL, interleukin 18 (IL‑18), and liver‑type fatty acid‑binding protein (L‑FABP) before, during, and within 3 days after surgery.


RESULTS
We observed a marked but nonsignificant increase in serum NGAL directly after clamp removal (75.21 ±55.83 vs. 46.37 ±21.60 ng/ml baseline value, P >0.05) and significantly elevated plasma NGAL at 2 hours (91.54 ±76.54 vs. baseline, P <0.05), 12 hours (100.78 ±44.92 vs. baseline, P <0.05) and 24 hours (89.46 ±94.18 vs. baseline, P <0.05) after clamp release. There was also significant elevation of urinary IL‑18 at 2 hours (51.60 [12.12-527.16] vs. 25.99 [9.34-187.80] pg/ml at baseline, P <0.05); L‑FABP at 2 hours (47.10 [5.40-500.00] vs. 5.50 (2.20-27.20) ng/ml at baseline, P <0.05) and 12 hours (39.00 [5.20-500.00] vs. baseline, P <0.05); NGAL at 12 hours (20.75 [5.00-176.10] vs. 5.85 [1.40-16.00] ng/ml at baseline, P <0.05) and 24 hours (13.95 [3.90-163.30] vs. baseline, P <0.05) after clamp release.


CONCLUSIONS
Elective AAA surgery may induce AKI. Novel markers can facilitate early detection of AKI, thus allowing to start therapy at an appropriate time point.
Department of Internal Medicine and Metabolic Diseases, Clinical Hospital No. 7, Medical University of Silesia, Upper Silesian Medical Center, Katowice, Poland. metabol@gcm.pl
Michał
M
Kokot
Grzegorz
G
Biolik
Damian
D
Ziaja
Tadeusz
T
Fojt
Kamila
K
Cisak
Katarzyna
K
Antoniak
Teresa
T
Kowalewska-Twardela
Krzysztof
K
Pawlicki
Krzysztof
K
Ziaja
Jan
J
Duława
D058186:Acute Kidney Injury / Q000097:blood* / Q000209:etiology; D000209:Acute-Phase Proteins; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D042241:Early Diagnosis; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D006801:Humans; D020382:Interleukin-18 / Q000097:blood*; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011044:Poland; D011237:Predictive Value of Tests; D011518:Proto-Oncogene Proteins / Q000097:blood*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D000209:Acute-Phase Proteins; D015415:Biomarkers; C493319:FABP1 protein, human; D050556:Fatty Acid-Binding Proteins; D020382:Interleukin-18; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins