Original InvestigationPathogenesis and Treatment of Kidney DiseaseUrinary Neutrophil Gelatinase-Associated Lipocalin and Acute Kidney Injury After Cardiac Surgery
Section snippets
Patients
All adult patients undergoing cardiac surgery at Columbia-University Medical Center, New York, NY, were eligible for inclusion in this study. The Institutional Review Board of Columbia University waived the requirement to obtain informed consent because urine collection is considered minimal risk by New York State and US Federal regulations. From July 26, 2004, to January 11, 2006, a total of 426 patients were enrolled. Approximately 2 to 3 patients per day were arbitrarily selected in the
Acute Kidney Injury
Eighty-five patients (20.0%) developed AKI, defined as an increase in serum creatinine level by more than 50% or more than 0.3 mg/dL within 48 hours after surgery. Patients who developed postoperative AKI (either definition) were older; had higher Parsonnet scores, greater body mass indexes, and longer CPB times and AXTs; and received aprotinin more frequently as an antifibrinolytic (Table 1). They also remained longer in the ICU and hospital and had greater in-hospital mortality.
Serum Creatinine After Cardiac Surgery
Serum
Discussion
We were able to show with this study that urinary NGAL levels correlate better than serum creatinine levels with indexes of intraoperative renal hypoperfusion (CPB time and AXT). Furthermore, patients who had long CPB times and AXTs showed increased NGAL levels, but had no significant change in serum creatinine levels. Urinary NGAL level immediately after surgery was significantly greater in patients with AKI, defined by using increases in serum creatinine levels compared with patients who did
Acknowledgements
Support: This work was funded by the intramural grant support from the Department of Anesthesiology, Columbia University College of Physicians and Surgeons. We would like to thank Antibodyshop, Entofte, Denmark, for supplying the NGAL ELISA kits.
Financial Disclosure: None.
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Originally published online as doi:10.1053/j.ajkd.2008.05.018 on July 25, 2008.