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Kidney-specific proteins in patients receiving aprotinin at high- and low-dose regimens during coronary artery bypass graft with cardiopulmonary bypass

Published online by Cambridge University Press:  26 August 2005

A. Faulí ,
C. Gomar ,
J. M. Campistol ,
L. Álvarez ,
A. M. Manig  and
P. Matute
A. Faulí
Affiliation:
University of Barcelona, Hospital Clínic, Department of Anesthesiology, Barcelona, Spain
C. Gomar
Affiliation:
University of Barcelona, Hospital Clínic, Department of Anesthesiology, Barcelona, Spain
J. M. Campistol
Affiliation:
University of Barcelona, Hospital Clínic, Department of Nephrology, Barcelona, Spain
L. Álvarez
Affiliation:
University of Barcelona, Hospital Clínic, Department of Biochemistry Laboratory, Barcelona, Spain
A. M. Manig
Affiliation:
University of Barcelona, Hospital Clínic, Department of Research and Development Board, Barcelona, Spain
P. Matute
Affiliation:
University of Barcelona, Hospital Clínic, Department of Anesthesiology, Barcelona, Spain
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Summary

Background and objective: The aim was to determine whether the administration of aprotinin can cause deleterious effects on renal function in cardiac surgery with cardiopulmonary bypass (CPB). Methods: Sixty consecutive patients with normal preoperative renal function undergoing elective coronary artery bypass surgery with CPB using the same anaesthetic; CPB and surgical protocols were randomized into three groups. Patients received placebo (Group 1), low-dose aprotinin (Group 2) or high-dose aprotinin (Group 3). Renal parameters measured were plasma creatinine, α1-microglobulin and β-glucosaminidase (β-NAG) excretion. Measurements were performed before surgery, during CPB and 24 and 72 h, and 7 and 40 days postoperatively. Results: In the three groups, α1-microglobulin and β-NAG excretions significantly increased during CPB, at 24 and 72 h, and 7 days postoperatively (P < 0.05) and had returned to preoperative levels at postoperative day 40. Plasma creatinine levels were within normal values at times recorded. In Groups 2 and 3, α1-microglobulin excretion during CPB was significantly higher than in Group 1 (P < 0.001), and 24 h after surgery it still remained significantly higher in Group 3 compared to Groups 1 and 2 (P < 0.05). Conclusions: Aprotinin caused a significant increase in α1-microglobulin excretion but not in β-NAG excretion during CPB, which may be interpreted as a greater renal tubular overload without tubular damage. This effect persisted for 24 h after surgery when high-dose aprotinin doses had been administered. Creatinine plasma levels were not sensitive to detect these prolonged renal effects in our study.

Keywords

APROTININKIDNEY FUNCTION TESTS, α1-microglobulin, β-glucosaminidaseCORONARY ARTERY BYPASSCARDIOPULMONARY BYPASS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 9 , September 2005 , pp. 666 - 671
Copyright
© 2005 European Society of Anaesthesiology

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