title: Increased prothrombotic property as a risk factor of acute kidney injury after surgical repair of abdominal aortic aneurysm: a prospective observational study.
abstract: BACKGROUND
  Acute kidney injury (AKI) is one of the major morbidities after surgical repair of abdominal aortic aneurysm (AAA); however, precise pathogenesis of this morbidity has not been well determined. Since prothrombotic coagulation abnormality may precede organ dysfunction in systemic inflammatory state, we examined the kinetics of von Willebrand factor (VWF) and a disintegrin-like metalloprotease with thrombospondin type 1 motif 13 (ADAMTS13), a cleaving enzyme of VWF, on the development of AKI after AAA surgery.
  
  
  METHODS
  The kinetics of ADAMTS13 and VWF were examined in ten patients who underwent surgical repair of AAA. The changes in plasma neutrophil gelatinase-associated lipocalin (NGAL), a novel biomarker for AKI, and serum creatinine concentration were also examined at four points until seventh postoperative day (POD). Clinical diagnosis of AKI was based on the change in serum creatinine concentration and urine output according to Acute Kidney Injury Network (AKIN) criteria.
  
  
  RESULTS
  ADAMTS13 activity was significantly lower than normal level before the surgery and showed a trend of decrease toward 3POD. The VWF/ADAMTS13 ratio showed a significant increase on 1POD, which persisted until 7POD. None of patents was diagnosed as AKI based on AKIN criteria, although two patients received furosemide and/or carperitide therapy because of decreased urine output less than 0.5 ml/kg/h for several hours in ICU. Plasma NGAL showed a trend to increase after the surgery, which was significant on 3POD. The change in plasma NGAL was significantly correlated with VWF/ADAMTS13 ratio (P < 0.01).
  
  
  CONCLUSIONS
  This study has shown that patients undergoing AAA surgery were prothrombotic after the surgery because of high VWF/ADAMTS13 ratio. Correlation between VWF/ADAMTS13 ratio and NGAL might indicate contribution of thrombotic event to subclinical AKI in the patients undergoing AAA surgery.
authors.affiliation: Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku 160-8582, Tokyo, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Innami
authors.affiliation: Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku 160-8582, Tokyo, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Katori
authors.affiliation: Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku 160-8582, Tokyo, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Mori
authors.affiliation: Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku 160-8582, Tokyo, Japan.
authors.forename: Shizuko
authors.initials: S
authors.lastname: Kosugi
authors.affiliation: Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku 160-8582, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku 160-8582, Tokyo, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Sakurai
authors.affiliation: Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku 160-8582, Tokyo, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Nagata
authors.affiliation: Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku 160-8582, Tokyo, Japan.
authors.forename: Junzo
authors.initials: J
authors.lastname: Takeda
authors.affiliation: Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku 160-8582, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Morisaki
keywords: ADAMTS13; AKI; Abdominal aortic aneurysm; Acute kidney injury; NGAL; Neutrophil gelatinase-associated lipocalin