title: Intraoperative renal near-infrared spectroscopy indicates developing acute kidney injury in infants undergoing cardiac surgery with cardiopulmonary bypass: a case-control study.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a frequent complication after cardiac surgery with cardiopulmonary bypass in infants. Renal near-infrared spectroscopy (NIRS) is used to evaluate regional oximetry in a non-invasive continuous real-time fashion, and reflects tissue perfusion. The aim of this study was to evaluate the relationship between renal oximetry and development of AKI in the operative and post-operative setting in infants undergoing cardiopulmonary bypass surgery.
  
  
  METHODS
  In this prospective study, we enrolled 59 infants undergoing cardiopulmonary bypass surgery for congenital heart disease for univentricular (n = 26) or biventricular (n = 33) repair. Renal NIRS was continuously measured intraoperatively and for at least 24 hours postoperatively and analysed for the intraoperative and first 12 hours, first 24 hours and first 48 hours postoperatively. The renal oximetry values were correlated with the paediatric risk, injury, failure, loss, end (pRIFLE) classification for AKI, renal biomarkers and the postoperative course.
  
  
  RESULTS
  Twenty-eight (48%) infants developed AKI based on pRIFLE classification. Already during intraoperative renal oximetry and further in the first 12 hours, 24 hours and 48 hours postoperatively, significantly lower renal oximetry values in AKI patients compared with patients with normal renal function were recorded (P < 0.05). Of the 28 patients who developed AKI, 3 (11%) needed renal replacement therapy and 2 (7%) died. In the non-AKI group, no deaths occurred. Infants with decreased renal oximetry values developed significantly higher lactate levels 24 hours after surgery. Cystatin C was a late parameter of AKI, and neutrophil gelatinase-associated lipocalin values were not correlated with AKI occurrence.
  
  
  CONCLUSIONS
  Our results suggest that prolonged low renal oximetry values during cardiac surgery correlate with the development of AKI and may be superior to conventional biochemical markers. Renal NIRS might be a promising non-invasive tool of multimodal monitoring of kidney function and developing AKI in infants undergoing cardiac surgery with cardiopulmonary bypass.
authors: Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University, Lazarettstr. 36, 80636, Munich, Germany. ruf@dhm.mhn.de.
authors: Bettina
authors: B
authors: Ruf
authors: Department of Anaesthesiology, German Heart Centre Munich, Technical University, Lazarettstr. 36, 80636, Munich, Germany. bonelli@dhm.mhn.de.
authors: Vittorio
authors: V
authors: Bonelli
authors: Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University, Lazarettstr. 36, 80636, Munich, Germany. balling@dhm.mhn.de.
authors: Gunter
authors: G
authors: Balling
authors: Department of Thoracic and Cardiovascular Surgery, German Heart Centre Munich, Technical University, Lazarettstr. 36, 80636, Munich, Germany. hoerer@dhm.mhn.de.
authors: Jürgen
authors: J
authors: Hörer
authors: Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University, Lazarettstr. 36, 80636, Munich, Germany. nagdyman@dhm.mhn.de.
authors: Nicole
authors: N
authors: Nagdyman
authors: Institute of Laboratory Medicine, German Heart Centre Munich, Technical University, Lazarettstr. 36, 80636, Munich, Germany. braun@dhm.mhn.de.
authors: Siegmund Lorenz
authors: SL
authors: Braun
authors: Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University, Lazarettstr. 36, 80636, Munich, Germany. prof.ewert@dhm.mhn.de.
authors: Peter
authors: P
authors: Ewert
authors: Department of Pediatric Intensive Care, University Children`s Hospital, von Haunersche Children hospital, Ludwigs-Maximilian University, Lindwurmstr. 4, 80337, Munich, Germany. karl.reiter@med.uni-muenchen.de.
authors: Karl
authors: K
authors: Reiter
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality; D015415:Biomarkers; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000401:mortality; D016022:Case-Control Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000098:blood supply / Q000293:injuries* / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared / Q000706:statistics & numerical data*
chemical_list: D015415:Biomarkers
references: J Pediatr Surg. 2010 Jun;45(6):1306-10
references: 20620336
references: Lancet. 2005 Apr 2-8;365(9466):1231-8
references: 15811456
references: J Am Soc Nephrol. 2011 Sep;22(9):1737-47
references: 21836147
references: Nephrol Dial Transplant. 2013 Feb;28(2):254-73
references: 23115326
references: J Thorac Cardiovasc Surg. 2004 Jan;127(1):223-33
references: 14752434
references: Clin J Am Soc Nephrol. 2006 Jan;1(1):19-32
references: 17699187
references: Clin J Am Soc Nephrol. 2008 May;3(3):665-73
references: 18337554
references: Kidney Int. 2009 Oct;76(8):885-92
references: 19641482
references: Ann Thorac Surg. 2012 Nov;94(5):1589-95
references: 22884599
references: Crit Care. 2007;11(6):R127
references: 18070344
references: Eur J Pediatr Surg. 2012 Dec;22(6):426-33
references: 22903254
references: Pediatr Crit Care Med. 2007 Mar;8(2):154-60
references: 17273125
references: Pediatr Cardiol. 2011 Feb;32(2):183-8
references: 21085945
references: J Thorac Cardiovasc Surg. 2012 Feb;143(2):368-74
references: 21798562
references: Kidney Int. 2007 May;71(10):1028-35
references: 17396113
references: Ann Thorac Surg. 2009 Jan;87(1):36-44; discussion 44-5
references: 19101265
references: J Cardiothorac Vasc Anesth. 2009 Oct;23(5):663-7
references: 19447648
references: World J Pediatr Congenit Heart Surg. 2011 Oct 1;2(4):536-40
references: 23804464
references: J Thorac Cardiovasc Surg. 2005 Dec;130(6):1523-30
references: 16307993
references: Pediatr Emerg Care. 2009 Mar;25(3):150-3
references: 19262423
references: J Thorac Cardiovasc Surg. 2002 Jan;123(1):110-8
references: 11782764
references: Paediatr Anaesth. 2008 Feb;18(2):160-6
references: 18184248
references: Pediatr Crit Care Med. 2014 Feb;15(2):121-30
references: 24366512
references: Pediatr Cardiol. 2011 Aug;32(6):748-53
references: 21445607
references: Pediatr Nephrol. 2013 Aug;28(8):1173-82
references: 23142867
references: Curr Opin Pediatr. 2011 Apr;23(2):194-200
references: 21252674
references: Crit Care Med. 2011 Jun;39(6):1493-9
references: 21336114
references: Eur J Cardiothorac Surg. 2003 May;23(5):728-33; discussion 733-4
references: 12754025
references: Circulation. 2010 Jul 20;122(3):245-54
references: 20606124
references: J Pediatr. 2011 Jun;158(6):1009-1015.e1
references: 21300375
references: Clin J Am Soc Nephrol. 2010 Sep;5(9):1552-7
references: 20538834
references: Br J Anaesth. 2009 Dec;103 Suppl 1:i3-13
references: 20007987
references: Acta Anaesthesiol Scand. 2013 Mar;57(3):373-9
references: 23210461
references: J Thorac Cardiovasc Surg. 2013 Oct;146(4):861-867.e1
references: 23317940
references: Pediatr Crit Care Med. 2008 Jan;9(1):62-8
references: 18477915
references: J Pediatr. 2013 Jan;162(1):120-7.e1
references: 22878115
references: Kidney Int. 2011 Sep;80(6):655-62
references: 21525851
references: Pediatr Crit Care Med. 2012 Sep;13(5):529-34
references: 22596064
references: Paediatr Anaesth. 2008 Dec;18(12):1163-9
references: 19076569