Very Transient Cases of Acute Kidney Injury in the Early Postoperative Period After Cardiac Surgery: The Relevance of More Frequent Serum Creatinine Assessment and Concomitant Urinary Biochemistry Evaluation

2016 ◽  
Vol 30 (1) ◽  
pp. 56-63 ◽  
Author(s):  
Alexandre Toledo Maciel ◽  
Antonio Paulo Nassar ◽  
Daniel Vitorio
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Serum Creatinine ◽  
Postoperative Period ◽  
Kidney Injury ◽  
Early Postoperative Period

scholarly journals PREDICTORS OF ACUTE KIDNEY INJURY DEVELOPMENT AFTER CARDIAC SURGERY UNDER CARDIOPULMONARY BYPASS

2021 ◽  
Vol 19 (2) ◽  
pp. 153-158
Author(s):  
D. I. Krachak ◽  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cystatin C ◽  
Postoperative Period ◽  
Kidney Injury ◽  
Early Postoperative Period ◽  
Kidney Damage ◽  
Total Serum ◽  
Modifiable Factors

Purpose: To identify the incidence of acute kidney injury in the early postoperative period in cardiac surgery patients operated under cardiopulmonary bypass, and to determine possible risk predictors of its development. Material and methods: Analysis of 103 case histories of patients was performed; 39 of these patients developed acute kidney injury of stages 1-3. Clinical and clinical laboratory data were collected and analyzed at the preoperative and intraoperative stages. Results: A total of 37.9% of patients developed signs of acute kidney injury. This group of patients tended to be older, and was initially characterized by statistically significantly higher levels of creatinine and cystatin C and reduced levels of total serum protein and hemoglobin. Analysis of the possible predictors of acute kidney injury revealed that at the preoperative stage, the level of cystatin C had the highest association with the development of kidney damage in the early postoperative period (OR 15.828, 95% CI 1.66-150.54, p=0.016) and exceeded the traditional marker – serum creatinine. Among intraoperative factors, the duration of cardiopulmonary bypass (OR 1.015, 95% CI 1.006-1.023, p=0.001) and severity of intraoperative hemolysis (OR 1.017, 95% CI 1.004-1.030, p=0.008) demonstrated the greatest association with kidney damage. Сonclusion: It has been found that the risk of acute kidney injury in patients with preexisting renal failure is two times higher than in patients with intact renal function. The most significant intraoperative modifiable factors affecting postoperative renal injury are the duration of cardiopulmonary bypass and the level of hemolysis.

scholarly journals Urine Biochemistry in the Early Postoperative Period after Cardiac Surgery: Role in Acute Kidney Injury Monitoring

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Alexandre Toledo Maciel ◽  
Daniel Vitório
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Postoperative Period ◽  
Kidney Injury ◽  
Early Postoperative Period ◽  
Mirror Image ◽  
Acute Kidney Injury Development ◽  
Urine Electrolytes ◽  
High Concentrations ◽  
Transient Aki

We have recently suggested that sequential urine electrolyte measurement in critically ill patients may be useful in monitoring kidney function. Cardiac surgery is one of the leading causes of acute kidney injury (AKI) in the intensive care unit (ICU). In this paper, we describe the sequential behavior of urine electrolytes in three patients in the early (first 60 hours) postoperative period after cardiac surgery according to AKI status: no AKI, transient AKI, and persistent AKI. We have found that the patient with no AKI had stable and high concentrations of sodium (NaU) and chloride (ClU) in sequential spot samples of urine. AKI development was characterized in the other two patients by decreases in NaU and ClU, which have started early after ICU admission. Transient AKI was marked by also transient and less severe decreases in NaU and ClU. Persistent AKI was marked by the less favorable clinical course with abrupt and prolonged declines in NaU and ClU values. These electrolytes in urine had a behavior like a “mirror image” in comparison with that of serum creatinine. We suggest that sequential urine electrolytes are useful in monitoring acute kidney injury development in the early postoperative period after cardiac surgery.

scholarly journals Perioperative evaluation of kidney function for patients with complicated forms of coronary artery disease

2020 ◽  
pp. 52-58
Author(s):  
O. Gogayeva ◽  
V. Lazoryshynets ◽  
A. Rudenko ◽  
L. Dzakhoieva ◽  
O. Yuvchyk
Keyword(s):  
Coronary Artery Disease ◽  
Acute Kidney Injury ◽  
Coronary Artery ◽  
Kidney Function ◽  
Postoperative Period ◽  
Kidney Injury ◽  
Perioperative Period ◽  
Early Postoperative Period ◽  
Chronic Obstructive ◽  
Artery Disease

The study aimed to analyze kidney function for patients with complicated forms of coronary artery disease (CAD) in the perioperative period. Methods. It was a retrospective analysis of 110 high-risk patients with complicated forms of CAD, who were operated on and discharged from the National M. Amosov Institute for the period from 2009 till 2019 years. Kidney function was evaluated by glomerular filtration rate (GFR), calculated online with СKD-EPI formula. Results. Among the included patients there were 86 (78.1%) patients with metabolic syndrome, 81 (73.59%) patients with disorders of glucose metabolism, 82 (74.5%) subjects with chronic obstructive pulmonary disease and 38 (34.5%) patients had chronic kidney disease (CKD) 3-5 stage. Preoperative risk stratification with EuroScore II scale was 9.4%. All operations performed in cardiopulmonary bypass; Custodial cardioplegia was used in 53 (48.1%) patients. The average perfusion time was 111 minutes, average cross-clamping time was 73.9 minutes. Acute kidney injury in the early postoperative period had 9 (8.1%) patients. Conclusions. At the admittance 38 (34.5%) patients with complicated forms of CAD had CKD 3-5 st. Analysis of the GFR dynamic in the early postoperative period shown a decrease in GFR in 71.05% of patients. Transient acute kidney injury with 50% sCr growth had 9 (8.1%) patients but didn’t require hemodialysis.

scholarly journals The Benefit of Sirolimus Maintenance Immunosuppression and Rabbit Antithymocyte Globulin Induction in Liver Transplant Recipients That Develop Acute Kidney Injury in the Early Postoperative Period

2015 ◽  
Vol 2015 ◽  
pp. 1-6
Author(s):  
Benjamin T. Duhart ◽  
Winston A. Ally ◽  
Amy G. Krauss ◽  
Joanna Q. Hudson ◽  
James D. Eason ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Liver Transplant ◽  
Postoperative Period ◽  
Antithymocyte Globulin ◽  
Kidney Injury ◽  
Early Postoperative Period ◽  
Transplant Recipients ◽  
Maintenance Immunosuppression ◽  
Rabbit Antithymocyte Globulin ◽  
Liver Transplant Recipients

Published data are limited describing renal outcomes in orthotopic liver transplant (OLT) recipients prescribed sirolimus (SRL) maintenance immunosuppression (MIS) and rabbit antithymocyte globulin (rATG) induction. We investigated whether SRL MIS and rATG induction facilitated recovery of acute kidney injury in the early postoperative period. This retrospective descriptive study screened 308 consecutive OLTs performed between 2006 and 2009. All patients received rATG induction with steroid avoidance. MIS consisted of SRL or TAC with mycophenolate mofetil. A total of 197 patients were included: 168 (85%) received TAC and 29 (15%) received SRL for a median of 365 days. Demographics were similar between groups except for a higher incidence of pretransplant renal dysfunction in the SRL recipients (SRL 59% versus TAC 21%;P<0.05). The eGFR was significantly (P<0.05) higher for all time points in the TAC group with the exception of month 2. However, improvement in eGFR was significantly (P<0.05) greater in the SRL group postoperatively. Our study suggests that rATG induction and SRL maintenance immunosuppression facilitate renal recovery for liver transplant recipients that develop acute kidney injury in the early postoperative period.

scholarly journals Effect of Ascorbic Acid on Postoperative Acute Kidney Injury in Coronary Artery Bypass Graft Patients: A Pilot Study

2017 ◽  
Vol 20 (5) ◽  
pp. 214 ◽  
Author(s):  
Miha Antonic
Keyword(s):  
Acute Kidney Injury ◽  
Ascorbic Acid ◽  
Cardiac Surgery ◽  
Coronary Artery ◽  
Serum Creatinine ◽  
Renal Injury ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Acid Group ◽  
Postoperative Serum

Background: Even minor postoperative reductions in renal function influence the outcome of cardiac surgery. The mechanisms of postoperative renal injury in cardiac surgery are multifactorial and include ischemia-reperfusion injury. The study investigates the effect of the antioxidant ascorbic acid on the postoperative acute kidney injury after elective CABG surgery.Methods: A prospective randomized single-center trial was conducted in on-pump coronary artery bypass patients. The patients in the ascorbic acid group received 2 grams of ascorbic acid 24 hours and 2 hours preoperatively and 1 gram twice daily five days after the surgery.  Postoperatively, the subjects were monitored for renal dysfunction and other complications.Results: 100 patients were included, with 50 patients in each study group. The groups were well matched for baseline demographics, preoperative medications, comorbidities, and had similar intraoperative characteristics. The incidence of postoperative acute kidney injury in the ascorbic acid group was 16% and 14% in the control group (P = .779). The groups also did not differ in peak postoperative serum creatinine (83 [33] µmol/L versus 83 [39] µmol/L; P = .434), the lowest postoperative creatinine clearance (96.40 ± 35.78 mL/min versus 90.89 ± 36.18 mL/min; P = .766), and time from surgery to the onset of peak postoperative serum creatinine (1.64 ± 1.34 days versus 1.92 ± 1.54 days; P = .393). There was no dialysis required in any patient. Conclusion: The results of this study did not demonstrate a significant protective effect of ascorbic acid on the incidence of postoperative acute renal injury in elective on-pump CABG patients.

scholarly journals Management of a Case of Aortic Valve Replacement with Left Ventricle Clot Removal Developing Acute Kidney Injury in Postoperative Period

2020 ◽  
Author(s):  
Naresh Kumar Aggarwal ◽  
Sushanta Bhoi
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Aortic Valve ◽  
Left Ventricle ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Postoperative Period ◽  
Severe Aortic Stenosis ◽  
Kidney Injury ◽  
Clot Removal

AbstractCardiac surgery associated-acute kidney injury (AKI) is a common and a serious complication of cardiac surgery requiring cardiopulmonary bypass and it is the second most common cause of AKI in intensive care unit. Recently, two consensus conferences have suggested new diagnostic criteria to define AKI and risk score to better identify patients who will develop AKI after cardiac surgery. In fact, prompt recognition of high-risk patients could allow a more aggressive management at a reversible stage of an incoming ARF. In this case report, we have discussed a case of 21-year-old patient with bicuspid aortic valve with severe aortic stenosis with ejection fraction 15% and left ventricle (LV) clot undergoing surgery for aortic valve replacement with LV clot removal. In the postoperative period, he developed AKI that was managed successfully by early intervention by slow low efficiency dialysis and diafiltration and hemodialysis and patient discharged successfully from hospital.

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