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 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 Preoperative hemoglobin and uric acid levels as risk factors for acute kidney injury in cardiac surgery patients

2020 ◽  
Vol 73 (1-2) ◽  
pp. 5-12
Author(s):  
Miodrag Golubovic ◽  
Andrej Preveden ◽  
Ranko Zdravkovic ◽  
Jelena Vidovic ◽  
Bojan Mihajlovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Uric Acid ◽  
Cardiac Surgery ◽  
Kidney Injury ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Preoperative Hemoglobin ◽  
Significant Difference ◽  
Acute Kidney Injury Development

Introduction. Acute kidney injury associated with cardiac surgery is a common and significant postoperative complication. With a frequency of 9 - 39% according to different studies, it is the second most common cause of acute kidney injury in intensive care units, and an independent predictor of mortality. This study aimed to investigate the importance of preoperative hemoglobin and uric acid levels as risk factors for acute kidney injury in the postoperative period in cardiac surgery patients. Material and Methods. The study included a total of 118 patients who were divided into two groups. Each group included 59 patients; the fist group included patients who developed acute kidney injury and required renal replacement therapy, and the second included patients without acute kidney injury. Types of cardiac surgery included coronary, valvular, combined, aortic dissection, and others. All necessary data were collected from patient medical records and the electronic database. Results. A statistically significant difference was found between the groups in preoperative hemoglobin levels (108.0 vs. 143.0 g/l, p = 0.0005); postoperative urea (26.4 vs. 5.8 mmol/l, p = 0.0005) and creatinine (371.0 vs. 95.0 ?mol/l, p = 0.0005), acute phase inflammatory reactants C-reactive protein (119.4 vs. 78.9 mg/l, p = 0.002) and procalcitonin (7.0 vs. 0.2 ng/ml, p = 0.0005), creatine kinase myocardial band isoenzyme (1045.0 vs. 647.0 mg/l, p = 0.014); duration of extracorporeal circulation (103.5 vs. 76.0 min, p = 0.0005) and ascending aortic clamp during cardiac surgery (89.0 vs. 67.0 min, p = 0.0005). The exception was the preoperative uric acid level, where there was no statistically significant difference (382.0 vs. 364.0 ?mol/l, p = 0.068). There was a statistically significant correlation between the use of inotropic agents and acute kidney injury development. Conclusion. There is a correlation between the preoperative low hemoglobin levels and postoperative acute kidney injury. There is no statistically significant correlation between the preoperative levels of uric acid and postoperative acute kidney injury.

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 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.

Is the use of hydroxyethyl starch as priming solution during cardiac surgery advisable? A randomized, single-center trial

Perfusion ◽  
2017 ◽  
Vol 33 (6) ◽  
pp. 483-489 ◽  
Author(s):  
Øyvind S. Svendsen ◽  
Marit Farstad ◽  
Arve Mongstad ◽  
Rune Haaverstad ◽  
Paul Husby ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Hydroxyethyl Starch ◽  
Kidney Injury ◽  
Study Groups ◽  
Early Postoperative Period ◽  
Fluid Loading ◽  
Fluid Accumulation ◽  
Fluid Filtration ◽  
Beneficial Effects

Introduction: The use of cardiopulmonary bypass (CPB) leads to increased fluid filtration and edema. The use of artificial colloids to counteract fluid extravasation during cardiac surgery is controversial. Beneficial effects on global fluid loading, leading to better cardiac performance and hemodynamics, have been claimed. However, renal function and coagulation may be adversely affected, with unfavorable impact on outcome following cardiac surgery. Methods: Forty patients were randomly allocated to study groups receiving either acetated Ringer’s solution (CT group) or hydroxyethyl starch (HES group, Tetraspan®) as CPB priming solution. Fluid balance, bleeding and hemodynamics, including cardiac output, were followed postoperatively. The occurrence of acute kidney injury was closely registered. Results: Two patients were excluded from further analyzes due to surgical complications. Fluid accumulation was attenuated in the HES group (3374 (883) ml) compared with the CT group (4328 (1469) ml) (p=0.024). The reduced perioperative fluid accumulation was accompanied by an increased cardiac index immediately after surgery (2.7 (0.4) L/min/m2 in the HES group and 2.1 (0.3) L/min/m2 in the CT group (p<0.001)). No increase in bleeding could be demonstrated in the HES group. Three patients, all of them in the HES group, experienced acute kidney injury postoperatively. Conclusions: CPB priming with HES solution lowers fluid loading during bypass and improves cardiac function in the early postoperative period. The manifestation of acute kidney injury exclusively in the HES group of patients raises doubts about the use of HES products in conjunction with cardiac surgery. ( https://clinicaltrials.gov/ct2/show/NCT01511120 )

Sign in / Sign up

Export Citation Format

Share Document