Urinary Interleukin-18 and Urinary Neutrophil Gelatinase-associated Lipocalin Predict Acute Kidney Injury Following Pulmonary Valve Replacement Prior to Serum Creatinine
Urinary Interleukin-18 and Urinary Neutrophil Gelatinase-associated Lipocalin Predict Acute Kidney Injury Following Pulmonary Valve Replacement Prior to Serum Creatinine
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DOI：
10.1111/j.1747-0803.2012.00662.x
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发表时间：
2012-09-01
影响因子：
0.3
通讯作者：
Earing, Michael G.
中科院分区：
文献类型：
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作者：
Buelow, Matthew W.;Dall, Aaron;Earing, Michael G.
背景资料。越来越多的人认识到先天性心脏病(CHD)的表现超越了心血管系统。导致冠心病患者肾功能不全的因素是多因素的，其中心脏手术时的急性肾损伤(AKI)起主要作用。AKI的诊断通常基于血肌酐和估计的肾小球滤过率(EGFR)的变化。这样的测量往往很晚，而且不准确。最近的研究表明，尿生物标志物白介素18(IL-18)和中性粒细胞明胶酶相关脂蛋白(NGAL)是AKI的早期标志物。我们试图确定尿IL-18和NGAL检测外科肺动脉瓣置换术(PVR)患者早期AKI的有效性。方法：研究方法。有圆锥干畸形修复史的20名接受PVR手术的患者入选。分别于术前、术后6、12、24、72小时采集尿样和血肌酐。测定尿液中NGAL和IL-18水平。使用风险、损伤、衰竭、损失和终末期肾病(RIFLE)分类系统测定AKI。结果。使用RIFLE分类系统，7名患者(35%)被发现有AKI，定义为EGFR下降或血清肌酐上升。所有7例AKI患者的尿液IL-18(6倍)和NGAL(26倍)均较术前显著升高。用NGAL和IL-18在术后6小时检测AKI，使常规方法在1236小时前发现AKI。未发现AKI的术前预测因素。结论。NGAL和IL-18都是AKI的早期预测生物标志物，并且在手术PVR后两者同时升高。重要的是，两者都在肌酐升高或EGFR降低之前升高。监测这两个生物标志物可能有助于在冠心病手术时及早发现并随后进行干预以预防AKI。
Background. It is becoming increasingly recognized that manifestations of congenital heart disease (CHD) extend beyond the cardiovascular system. The factors contributing to renal dysfunction in patients with CHD are multifactorial, with acute kidney injury (AKI) at time of cardiac surgery playing a major role. AKI is often diagnosed based on changes in serum creatinine and estimated glomerular filtration rate (eGFR). Such measurements are often late and imprecise. Recent data indicate that urinary biomarkers interleukin-18 (IL-18) and neutrophil gelatinase-associated lipocalin (NGAL) are earlier markers of AKI. We sought to determine the efficacy of urinary IL-18 and NGAL for detecting early AKI in patients undergoing surgical pulmonary valve replacement (PVR). Methods. Twenty patients presenting for surgical PVR with a history of previous repair of a conotruncal anomaly were enrolled. Preoperative clinical data were measured and urine samples and serum creatinine were collected at 6, 12, 24, and 72 hours post bypass. Urine was evaluated for NGAL and IL-18. AKI was determined using the Risk, Injury, Failure, Loss and End Stage Renal Disease (RIFLE) classification system. Results. Using the RIFLE classification system, seven patients (35%) were found to have AKI defined as a drop in the eGFR or an increase in serum creatinine. All seven patients with AKI had marked increase from preoperative baseline in urine IL-18 (sixfold) and NGAL (26-fold). Using NGAL and IL-18, AKI was detected at 6 hours postoperatively, resulting in AKI being identified 1236 hours prior to detection by conventional methods. No preoperative predictors for AKI were identified. Conclusion. Both NGAL and IL-18 are early predictive biomarkers of AKI, and both increase in tandem after surgical PVR. Importantly, both rise before an increase in creatinine or a decrease in eGFR is present. Monitoring both biomarkers may allow for earlier detection and subsequent interventions to prevent AKI at time of surgery for CHD.