title: Clinical usefulness of urinary liver-type fatty-acid-binding protein as a perioperative marker of acute kidney injury in patients undergoing endovascular or open-abdominal aortic aneurysm repair.
abstract: OBJECTIVE
  Acute kidney injury (AKI) is common after cardiovascular surgery and is usually diagnosed on the basis of the serum creatinine (SCr) level and urinary output. However, SCr is of low sensitivity in patients with poor renal function. Because urinary liver-type fatty-acid-binding protein (L-FABP) reflects renal tubular injury, we evaluated whether perioperative changes in urinary L-FABP predict AKI in the context of abdominal aortic repair.
  
  
  METHODS
  Study participants were 95 patients who underwent endovascular abdominal aortic aneurysm repair (EVAR) and 42 who underwent open repair. We obtained urine samples before surgery, after anesthesia induction, upon stent placement, before aortic cross-clamping (AXC), 1 and 2 h after AXC, at the end of surgery, 4 h after surgery, and on postoperative days (PODs) 1, 2, and 3, for measurement of L-FABP. We obtained serum samples before surgery, immediately after surgery, and on PODs 1, 2, and 3, for measurement of SCr. We also plotted receiver-operating characteristic (ROC) curves to identify cutoff laboratory values for predicting the onset of AKI.
  
  
  RESULTS
  With EVAR, urinary L-FABP was significantly increased 4 h after the procedure (P = 0.014). With open repair, urinary L-FABP increased significantly to its maximum by 2 h after AXC (P = 0.007). With AKI, SCr significantly increased (P < 0.001, P = 0.001) by POD 2. ROC analysis showed urinary L-FABP to be more sensitive than SCr for early detection of AKI.
  
  
  CONCLUSIONS
  Urinary L-FABP appears to be a sensitive biomarker of AKI in patients undergoing abdominal aortic repair.
authors.affiliation: Department of Anesthesiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, 216-8511, Japan. y2obata@marianna-u.ac.jp.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Obata
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan. a2kamijo@marianna-u.ac.jp.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Kamijo-Ikemori
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan. ichikawa6008@gmail.com.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan. takeshi-sugaya@marianna-u.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sugaya
authors.affiliation: Tokyo Takanawa Hospital, Tokyo, Japan. kimura@marianna-u.ac.jp.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan. shibagaki@marianna-u.ac.jp.
authors.forename: Yugo
authors.initials: Y
authors.lastname: Shibagaki
authors.affiliation: Department of Anesthesiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, 216-8511, Japan. t2tateda@marianna-u.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tateda
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D015415:Biomarkers / Q000652:urine; D057510:Endovascular Procedures / Q000379:methods*; D050556:Fatty Acid-Binding Proteins / Q000652:urine*; D005260:Female; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies; D012372:ROC Curve
chemical_list: D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins
keywords: Abdominal aortic repair; Acute kidney injury; Urinary liver-type fatty-acid-binding protein