Tubular nephrotoxicity after cardiac surgery utilising cardiopulmonary bypass

Justin Westhuyzen, David C. McGiffin, John McCarthy, Simon J. Fleming

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Abstract

Markers of renal tubular injury were examined in 21 patients (16 male, 5 female, mean age 57.4 years) undergoing cardiac surgery utilising cardiopulmonary bypass. Postoperative urine outputs were very high (200-250 ml/h at 1-2 h), decreasing to 100 ml/h by 6 h. Although creatinine clearances did not vary significantly in the postoperative period (P = 0.16), significant changes were noted in the urinary concentrations of three tubular markers relative to creatinine concentration (P < 0.001). Urinary β2-microglobulin increased from negligible levels (median 0.01 mg/mmol creatinine) to peak at 4 h (median 4.55 mg/mmol), in part due to interference with its reabsorption by the plasma volume expander Haemaccel. Concentrations of the brush border antigen adenosine deaminase binding protein increased 6-fold, from a median of 5.03 arbitrary units (AU)/ μmol to 31.2 AU/ μmol at 48 h. The lysosomal enzyme N-acetyl-β-d-glucosaminidase increased nearly 4-fold, from 0.68 units/mmol to 2.64 units/ mmol at 48 h. Our results suggest that cardiac surgery utilising cardiopulmonary bypass is associated with acute tubular injury which can occur in the absence of overt changes in creatinine clearance.

Original languageEnglish
Pages (from-to)123-132
Number of pages10
JournalClinica Chimica Acta
Volume228
Issue number2
DOIs
Publication statusPublished - Aug 1994
Externally publishedYes

Keywords

  • Cardiac surgery
  • Cardiopulmonary bypass
  • Creatinine clearance
  • Kidney failure
  • Kidney function tests
  • Tubular markers
  • Urine

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