nach oben

Erschienen in:

01.05.2014 | Original Article

Near-infrared spectroscopy as continuous real-time monitoring for kidney graft perfusion

verfasst von: Enrico Vidal, Angela Amigoni, Valentina Brugnolaro, Giulia Ghirardo, Piergiorgio Gamba, Andrea Pettenazzo, Giovanni Franco Zanon, Chiara Cosma, Mario Plebani, Luisa Murer

Erschienen in: Pediatric Nephrology | Ausgabe 5/2014

Einloggen, um Zugang zu erhalten

Abstract

Background

Near-infrared spectroscopy (NIRS) is a non-invasive technique designed to study regional oxygenation (rSO₂) by measuring the absorption of chromophores. This study investigated the role of NIRS in the real-time monitoring of kidney graft perfusion for 72 h post-transplantation.

Methods

Consecutive children undergoing living related donor (LRD) or deceased donor (DD) kidney transplantation (KTP) were prospectively enrolled between April 2010 and August 2011. Renal rSO₂ values were registered continuously for 3 days and correlated with hourly urine output, serum creatinine, and urinary neutrophil gelatinase-associated lipocalin (u-NGAL).

Results

Twenty-four children were included, 6 underwent LRD and 18 DD KTP. Median age was 12.5 years (interquartile range [IQR] 3.5–16.6) and median body weight was 37 kg (IQR 13–49.7). Four patients experienced delayed graft function (DGF). Renal Doppler ultrasound showed normal vascularization patterns in all children. Median basal renal rSO₂ value was 68.8 % (IQR 59.3–76.2), significantly lower than the end-of-period result (83.6 %; IQR 79.2–90.4; p < 0.0001). Renal rSO₂ values showed significant correlation with serum creatinine (r_s = −0.62; p < 0.05) and estimated glomerular filtration rate (eGFR) (r_s = 0.64; p < 0.05). No correlation was shown between rSO₂ and diuresis. Increased rSO₂ was also found in patients who experienced DGF. u-NGAL exhibited a trend toward a decrease from baseline in both DD and LRD KTPs, with a strong negative correlation with rSO₂.

Conclusions

rSO₂ assessed by NIRS strongly correlates with common markers of kidney graft function and perfusion, allowing continuous real-time monitoring of blood flow in renal grafts.

Dimitroulis D, Bokos J, Zavos G, Nikiteas N, Karidis NP, Katsaronis P, Kostakis A (2009) Vascular complications in renal transplantation: a single-center experience in 1367 renal transplantations and review of the literature. Transplant Proc 41:1609–1614PubMedCrossRef

McDonald RA, Smith JM, Stablein D, Harmon WE (2003) Pretransplant peritoneal dialysis and graft thrombosis following pediatric kidney transplantation: a NAPRTCS report. Pediatr Transplant 7:204–208PubMedCrossRef

Baxter GM (2001) Ultrasound of renal transplantation. Clin Radiol 56:802–818PubMedCrossRef

Daubeney PE, Smith DC, Pilkington SN, Lamb RK, Monro JL, Tsang VT, Livesey SA, Webber SA (1998) Cerebral oxygenation during pediatric cardiac surgery: identification of vulnerable periods using near infrared spectroscopy. Eur J Cardiothorac Surg 13:370–377PubMedCrossRef

Hoffman GM, Stuth EA, Jaquiss RD, Vanderwal PL, Staudt SR, Troshynski TJ, Ghanayem NS, Tweddell JS (2004) Changes in cerebral and somatic oxygenation during stage 1 palliation of hypoplastic left heart syndrome using continuous regional cerebral perfusion. J Thorac Cardiovasc Surg 127:223–233PubMedCrossRef

Amigoni A, Mozzo E, Brugnaro L, Tiberio I, Pittarello D, Stellin G, Bonato R (2011) Four-side near-infrared spectroscopy measured in a paediatric population during surgery for congenital heart disease. Interact Cardiovasc Thorac Surg 12:707–712PubMedCrossRef

Marimón GA, Dockery WK, Sheridan MJ, Agarwal S (2012) Near-infrared spectroscopy cerebral and somatic (renal) oxygen saturation correlation to continuous venous oxygen saturation via intravenous oximetry catheter. J Crit Care 27:314.e13–314.e18CrossRef

Možina H, Podbegar M (2011) Near-infrared spectroscopy for evaluation of global and skeletal muscle tissue oxygenation. World J Cardiol 3:377–382PubMedCentralPubMedCrossRef

Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637PubMedCentralPubMedCrossRef

10.

Haase-Fielitz A, Haase M, Bellomo R (2009) Instability of urinary NGAL during long-term storage. Am J Kidney Dis 53:564–565PubMedCrossRef

11.

Bessede T, Droupy S, Hammoudi Y, Bedretdinova D, Durrbach A, Charpentier B, Benoit G (2012) Surgical prevention and management of vascular complications of kidney transplantation. Transpl Int 25:994–1001PubMedCrossRef

12.

Cornell LD, Smith RN, Colvin RB (2008) Kidney transplantation: mechanisms of rejection and acceptance. Annu Rev Pathol 3:189–220PubMedCrossRef

13.

Mishra J, Ma Q, Prada A, Mitsnefes M, Zahedi K, Yang J, Barasch J, Devarajan P (2003) Identification of neutrophil gelatinase-associated lipocalin as a novel early biomarker for ischemic renal injury. J Am Soc Nephrol 14:2534–2543PubMedCrossRef

14.

Hollmen ME, Kyllonen LE, Inkinen KA, Lalla MLT, Salmela KT (2011) Urine neutrophil gelatinase-associated lipocalin is a marker of graft recovery after kidney transplantation. Kidney Int 79:89–98PubMedCrossRef

15.

Parikh CR, Jani A, Mishra J, Ma Q, Kelly C, Barasch J, Edelstein CL, Devarajan P (2006) Urine NGAL and IL-18 are predictive biomarkers for delayed graft function following kidney transplantation. Am J Transplant 6:1639–1645PubMedCrossRef

16.

Oken DE (1975) Acute renal failure (vasomotor nephropathy): micropuncture studies of the pathogenetic mechanisms. Annu Rev Med 26:307–319PubMedCrossRef

17.

Sabbatini M, Sansone G, Uccello F, De Nicola L, Giliberti A, Sepe V, Margri P, Conte G, Andreucci VE (1994) Functional versus structural changes in the pathophysiology of acute ischemic renal failure in aging rats. Kidney Int 45:1355–1361PubMedCrossRef

18.

Vaughan DL, Wickramasinghe YA, Russell GI, Thorniley MS, Houston RF, Ruban E, Rolfe P (1995) Near infrared spectroscopy: blood and tissue oxygenation in renal ischemia-reperfusion injury in rats. Int J Angiol 4:25–30CrossRef

19.

David-Walek T, Steinhoff J, Fricke L, Sack K (1998) Excessive polyuria after renal transplantation. Nephron 78:334–335PubMedCrossRef

Titel: Near-infrared spectroscopy as continuous real-time monitoring for kidney graft perfusion
verfasst von: Enrico Vidal
Angela Amigoni
Valentina Brugnolaro
Giulia Ghirardo
Piergiorgio Gamba
Andrea Pettenazzo
Giovanni Franco Zanon
Chiara Cosma
Mario Plebani
Luisa Murer
Publikationsdatum: 01.05.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Nephrology / Ausgabe 5/2014
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-013-2698-y

Neu im Fachgebiet Pädiatrie

Klimaschutz beginnt bei der Wahl des Inhalators

14.05.2024 Klimawandel Podcast

Auch kleine Entscheidungen im Alltag einer Praxis können einen großen Beitrag zum Klimaschutz leisten. Die neue Leitlinie zur "klimabewussten Verordnung von Inhalativa" geht mit gutem Beispiel voran, denn der Wechsel vom klimaschädlichen Dosieraerosol zum Pulverinhalator spart viele Tonnen CO₂. Leitlinienautor PD Dr. Guido Schmiemann erklärt, warum nicht nur die Umwelt, sondern auch Patientinnen und Patienten davon profitieren.

Update Pädiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Near-infrared spectroscopy as continuous real-time monitoring for kidney graft perfusion