title: Cystatin C for early detection of acute kidney injury after laparoscopic partial nephrectomy.
abstract: OBJECTIVE
  Mortality due to AKI has not changed significantly over the past 50 years. This is due in part to failure to detect early AKI and to initiate appropriate therapeutic measures. There is therefore a need to identify biomarkers that would improve the early detection of AKI. The objective of this study was to assess whether cystatin C levels obtained at specific timepoints during laparoscopic partial nephrectomy (PN) could be early predictors of AKI.
  
  
  METHODS
  Twenty-five patients underwent laparoscopic PN for organ-confined tumors. All procedures were performed by two surgeons in a single institution. Plasma samples were collected preoperatively, and post-unclamping at 5, 20, 120 min and on the day following surgery. Plasma cystatin C was measured by enzyme-linked immunosorbent assay. Correlation between levels of cystatin C and other parameters of interest were assessed in order to define cystatin C ability to predict AKI and loss of renal function following laparoscopic PN.
  
  
  RESULTS
  The mean baseline eGFR was 93 ml/min/1.73 m(2). Warm ischemia time varied between 16 and 44 min. Post-operative day 1 (POD1) cystatin C levels compared to baseline were increased in 13 (52%) of the patients. There was a high correlation between the difference of POD 1 and baseline value, and eGFR in the immediate postoperative period (r = -0.681; P = 0.0002) and at 12-month follow-up (r = -0.460, P = 0.048). However, the variation in cystatin C levels at earlier timepoints were not associated to AKI nor renal function.
  
  
  CONCLUSIONS
  High increase in POD 1 cystatin C levels from baseline may help identify patients with AKI and those at higher risk of chronic kidney disease, following laparoscopic PN.
authors.affiliation: Department of Urology of Laval University, CHU de Québec - L'Hôtel-Dieu de Québec, Québec, Qc, Canada ; Laval University Cancer Research Centre, CHU de Québec - L'Hôtel-Dieu de Québec, Québec, Qc, Canada.
authors.forename: Anwar
authors.initials: A
authors.lastname: Alesawi
authors.affiliation: Department of Urology of Laval University, CHU de Québec - L'Hôtel-Dieu de Québec, Québec, Qc, Canada ; Laval University Cancer Research Centre, CHU de Québec - L'Hôtel-Dieu de Québec, Québec, Qc, Canada.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Nadeau
authors.affiliation: Laval University Cancer Research Centre, CHU de Québec - L'Hôtel-Dieu de Québec, Québec, Qc, Canada.
authors.forename: Alain
authors.initials: A
authors.lastname: Bergeron
authors.affiliation: Department of Urology of Laval University, CHU de Québec - L'Hôtel-Dieu de Québec, Québec, Qc, Canada.
authors.forename: Thierry
authors.initials: T
authors.lastname: Dujardin
authors.affiliation: Department of Urology of Laval University, CHU de Québec - L'Hôtel-Dieu de Québec, Québec, Qc, Canada ; Laval University Cancer Research Centre, CHU de Québec - L'Hôtel-Dieu de Québec, Québec, Qc, Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: Lacombe
authors.affiliation: Department of Urology of Laval University, CHU de Québec - L'Hôtel-Dieu de Québec, Québec, Qc, Canada ; Laval University Cancer Research Centre, CHU de Québec - L'Hôtel-Dieu de Québec, Québec, Qc, Canada.
authors.forename: Yves
authors.initials: Y
authors.lastname: Caumartin
keywords: Cystatin c; laparoscopy; partial nephrectomy; renal function; warm ischemia