Pattern of renal dysfunction associated with myocardial revascularization surgery and cardiopulmonary bypass
Pattern of renal dysfunction associated with myocardial revascularization surgery and cardiopulmonary bypass
复制标题
心肌血运重建手术和体外循环相关的肾功能障碍模式
DOI：
10.1017/s0265021503000693
复制
发表时间：
2003
影响因子：
3.6
通讯作者：
P. Matute
中科院分区：
文献类型：
--
作者：
A. Faulí;C. Gomar;J. Campistol;L. Alvarez;A. Manig;P. Matute
背景和目的：已有报道称体外循环心脏手术后肾功能障碍的发生率不同(3-35%)。目的是以白蛋白、免疫球蛋白(Ig G)、1微球蛋白和氨基葡萄糖苷酶(NAG)排泄为指标，确定体外循环冠状动脉手术后肾功能不全的典型模式。方法：对20例心内直视下择期心肌血运重建术患者进行前瞻性研究，术前肾功能以血肌酐、肌酐清除率、钠排泄分数和肾脏蛋白排泄为标准。记录的变量是人口统计学和血流动力学变量、体外循环和主动脉阻断时间、术中和术后尿量、血浆肌酐浓度、肌酐清除量和钠、白蛋白、免疫球蛋白、-氨基葡萄糖苷酶(&BGR；-NAG)和-AGR；1-微球蛋白的排泄。分别于术前、术前、术中、术后即刻，术后1、24、72h、7、40d复查。结果：体外循环期间白蛋白和免疫球蛋白排泄量显著升高(P<；0.05)，术后24小时仍维持在上述水平。体外循环期间血浆-AGR；1-微球蛋白和-BGR；-NAG浓度明显升高(P<；0.05)，并持续到术后第7天，部分患者在术后第40天仍有升高。这与术前糖尿病(P<；0.001)、体外循环后低心输出量(P<；0.001)以及在重症监护病房的住院时间(P<；0.001)有关。结论：体外循环心肌血运重建术后肾功能损害以肾小球和肾小管的暂时性肾功能损害为特征，起病时间在术后24 h内，持续时间为24 h~40 d。
Background and objective: A variable incidence rate of renal dysfunction (3–35%) after cardiac surgery with cardiopulmonary bypass has been reported. The aim was to define the typical pattern of renal dysfunction that follows coronary surgery with cardiopulmonary bypass using albumin, immunoglobulin (IgG), &agr;1‐microglobulin and &bgr;‐glucosaminidase (&bgr;‐NAG) excretion as indicators. Methods: Twenty patients with preoperative normal renal function, defined by plasma creatinine, creatinine clearance, fractional excretion of sodium and renal excretion of proteins, undergoing elective myocardial revascularization surgery with cardiopulmonary bypass, were prospectively studied. Variables recorded were demographic and haemodynamic variables, duration of cardiopulmonary bypass and aortic clamping, intra‐ and postoperative urine output, plasma creatinine concentration, creatinine clearance and excretion of sodium, albumin, IgG, &bgr;‐glucosaminidase (&bgr;‐NAG), and &agr;1‐microglobulin. Measurements were made preoperatively, immediately before and then during and immediately after cardiopulmonary bypass, and again at 1, 24, 72 h, 7 and 40 days following surgery. Results: Albumin and IgG excretion rose significantly during cardiopulmonary bypass (P < 0.05), remaining at these levels at 24 h postoperatively. An increase of &agr;1‐microglobulin and &bgr;‐NAG concentrations was observed during cardiopulmonary bypass (P < 0.05), which were maintained until the seventh postoperative day and remained elevated in some patients at the 40th postoperative day. This correlated with preoperative diabetes mellitus (P < 0.001), low cardiac output after cardiopulmonary bypass (P < 0.001) and the duration of stay in the intensive care unit (P < 0.001). Conclusions: The pattern of renal dysfunction after cardiopulmonary bypass for myocardial revascularization is characterized by temporary renal dysfunction at both glomerular and tubular levels with an onset within 24 h of surgery and which lasts between 24 h and 40 days, respectively, following surgery.
肾小管摄取蛋白质：分子电荷的影响。
DOI：
10.1152/ajprenal.1983.244.4.f436
发表时间：
1983
期刊：
The American journal of physiology
影响因子：
--
作者：
Christensen,EI;Rennke,HG;Carone,FA
通讯作者：
Carone,FA
肾小球滤过和蛋白尿的结构和功能基础的现状。
影响因子：
3.3
作者：
Kanwar,YS;Liu,ZZ;Kashihara,N;Wallner,EI
通讯作者：
Wallner,EI