title: The protective effect of human atrial natriuretic peptide on renal damage during cardiac surgery.
abstract: OBJECTIVE
  Acute kidney injury (AKI) is one of the critical complications after cardiac surgery. In the kidney, angiotensin II (Ang II) is formed by independent mechanisms, and activity of the intrarenal renin-angiotensin-aldosterone (RAAS) system contributes to the progression of kidney damage. Although atrial natriuretic peptide (ANP) exerts protective effects against renal injury by inhibiting the RAAS, the mechanisms of this effect have not been completely clarified. We investigated how human ANP (hANP) could prevent renal damage induced by cardiopulmonary bypass.
  
  
  METHODS
  Forty-eight patients undergoing cardiac surgery were divided into two groups, with and without hANP infusion. Urinary angiotensinogen, neutrophil gelatinase-associated lipocalin (NGAL) and L-type fatty acid-binding protein (L-FABP) were measured during and after surgery in both groups. Plasma renin activity, Ang II, aldosterone and serum creatinine were also measured.
  
  
  RESULTS
  Urinary angiotensinogen levels in the hANP group were significantly lower than in the non-hANP group after cardiopulmonary bypass surgery, at the end of surgery and 3 h after surgery. At 3 h after surgery, urinary NGAL levels in the hANP and non-hANP groups were 371.1 ± 413.6 and 761.4 ± 437.8 μg/gCr, respectively (p < 0.01). Urinary L-FABP levels at the end of surgery in the hANP and non-hANP groups were 238.8 ± 107.4 and 573.9 ± 370.1 μg/gCr, respectively (p < 0.01). Moreover, hANP seemed to significantly reduce the incidence of postoperative AKI.
  
  
  CONCLUSIONS
  hANP demonstrated renal protective effects during cardiac surgery, and could possibly reduce the incidence of AKI after ischemia-reperfusion surgery. Moreover, this protective effect of hANP is likely induced by inhibition of the intrarenal RAAS.
authors.affiliation: Department of Anesthesiology and Intensive Care, Kagoshima University Hospital, Sakuragaoka 8-35-1, Kagoshima, 46201, Japan. takmor@m3.kufm.kagoshima-u.ac.jp.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Moriyama
authors.affiliation: Department of Anesthesiology and Intensive Care, Kagoshima University Hospital, Sakuragaoka 8-35-1, Kagoshima, 46201, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Hagihara
authors.affiliation: Department of Anesthesiology and Intensive Care, Kagoshima University Hospital, Sakuragaoka 8-35-1, Kagoshima, 46201, Japan.
authors.forename: Toko
authors.initials: T
authors.lastname: Shiramomo
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, 3-1-1 Maida, Higashi-ku, Fukuoka, Japan.
authors.forename: Misaki
authors.initials: M
authors.lastname: Nagaoka
authors.affiliation: Department of Anesthesiology and Intensive Care, Kagoshima University Hospital, Sakuragaoka 8-35-1, Kagoshima, 46201, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Iwakawa
authors.affiliation: Department of Anesthesiology and Intensive Care, Kagoshima University Hospital, Sakuragaoka 8-35-1, Kagoshima, 46201, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kanmura
mesh_terms: D058186:Acute Kidney Injury / Q000517:prevention & control*; D000368:Aged; D000804:Angiotensin II / Q000097:blood; D009320:Atrial Natriuretic Factor / Q000494:pharmacology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D050556:Fatty Acid-Binding Proteins / Q000652:urine; D005260:Female; D006801:Humans; D007668:Kidney / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period
chemical_list: D050556:Fatty Acid-Binding Proteins; D000804:Angiotensin II; D009320:Atrial Natriuretic Factor
keywords: Acute kidney injury; Cardiac surgery; Human atrial natriuretic peptide; Renin–angiotensin system