title: Early prediction of acute kidney injury biomarkers after endovascular stent graft repair of aortic aneurysm: a prospective observational study.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a common and serious condition usually detected some time after onset by changes in serum creatinine (sCr). Although stent grafting to repair aortic aneurysms is associated with AKI caused by surgical procedures or the use of contrast agents, early biomarkers for AKI have not been adequately examined in stent graft recipients. We studied biomarkers including urinary neutrophil gelatinase-associated lipocalin (NGAL), blood NGAL, N-acetyl-β-d-glucosaminidase (NAG), microalbumin (Alb), and liver fatty acid-binding protein (L-FABP) as prospective early biomarkers for AKI in patients who had received stent graft repairs of aortic aneurysms.
  
  
  METHODS
  In addition to pre-surgical sampling, at 2 to 6 h and at 1, 3 to 4, and 5 days or later (until stable) after surgery, urine and serum biomarkers were sampled from 47 patients who underwent stent graft repair of aortic aneurysms.
  
  
  RESULTS
  Using Acute Kidney Injury Network criteria, 6 (14%) of 42 retained patients developed AKI. NGAL corrected with urine Cr (NGAL/Cr) values demonstrated the best predictive value for AKI (97% specificity, 83% sensitivity at a 65.1 μg/gCr cutoff). The area under the receiver-operator characteristic curve of NGAL/Cr value 2 h after surgery was 0.9. Although NGAL/Cr, L-FABP corrected with urine Cr (L-FABP/Cr), L-FABP, NAG, and Alb corrected by urine Cr (Alb/Cr) all reached peak values before AKI detection by sCr in AKI patients, all biomarkers reached the cutoff value before AKI detection after adaption of cutoff value.
  
  
  CONCLUSIONS
  After stent graft repair of aortic aneurysm, NGAL/Cr is a potentially useful early biomarker for AKI.
authors.affiliation: Department of Anesthesiology and Intensive Care, Graduate School of Medicine, Osaka University, 2-15, Yamadaoka, Suita 565-0871, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Ueta
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku 260-8670, Chiba, Japan.
authors.forename: Michiko
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Anesthesiology and Intensive Care, Graduate School of Medicine, Osaka University, 2-15, Yamadaoka, Suita 565-0871, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Iguchi
authors.affiliation: Department of Anesthesiology and Intensive Care, Graduate School of Medicine, Osaka University, 2-15, Yamadaoka, Suita 565-0871, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Uchiyama
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, 2-15, Yamadaoka, Suita 565-0871, Japan.
authors.forename: Yukitoshi
authors.initials: Y
authors.lastname: Shirakawa
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, 2-15, Yamadaoka, Suita 565-0871, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Kuratani
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, 2-15, Yamadaoka, Suita 565-0871, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sawa
authors.affiliation: Department of Anesthesiology and Intensive Care, Graduate School of Medicine, Osaka University, 2-15, Yamadaoka, Suita 565-0871, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Fujino
keywords: Acute kidney injury; Biomarkers; Endovascular aortic repair; Neutrophil gelatinase-associated lipocalin