Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-05T19:48:19.315Z Has data issue: false hasContentIssue false
  • English
  • Français

Pattern of renal dysfunction associated with myocardial revascularization surgery and cardiopulmonary bypass

Published online by Cambridge University Press:  11 July 2005

A. Faulí ,
C. Gomar ,
J. M. Campistol ,
L. Alvarez ,
A. M. Manig  and
P. Matute
A. Faulí
Affiliation:
University of Barcelona, Department of Anaesthesiology, Hospital Clinic, Barcelona, Spain
C. Gomar
Affiliation:
University of Barcelona, Department of Anaesthesiology, Hospital Clinic, Barcelona, Spain
J. M. Campistol
Affiliation:
University of Barcelona, Department of Nephrology, Hospital Clinic, Barcelona, Spain
L. Alvarez
Affiliation:
University of Barcelona, Laboratory of Biochemistry, Hospital Clinic, Barcelona, Spain
A. M. Manig
Affiliation:
University of Barcelona, Investigation and Development Board, Hospital Clinic, Barcelona, Spain
P. Matute
Affiliation:
University of Barcelona, Department of Anaesthesiology, Hospital Clinic, Barcelona, Spain
Get access

Extract

Summary

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), α1-microglobulin and β-glucosaminidase (β-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, β-glucosaminidase (β-NAG), and β-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 α1-microglobulin and β-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.

Keywords

BLOOD PROTEINS, immunoglobulin G, immunoglobulins, serum globulinsCARDIAC SURGICAL PROCEDURES, coronary artery bypass, myocardial revascularizationENZYMES, glucosaminidase, glycoside hydrolases, hexosaminidases, hydrolasesKIDNEY FUNCTION TESTS, glomerular filtration rate, radioisotope renographySURGICAL PROCEDURES, OPERATIVE, cardiopulmonary bypass, extracorporeal circulationUROLOGICAL DISEASES, albuminuria, proteinuria
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 6 , June 2003 , pp. 443 - 450
Copyright
© 2003 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Gailiunas P Jr, Chawla R, Lazarus JM, Cohn L, Sanders J, Merrill JP. Acute renal failure following cardiac operations. J Thorac Cardiovasc Surg 1980; 79: 241–243.Google Scholar
Hilberman L, Derby GC, Spencer RJ, Stinson EB. Sequential pathophysiological changes characterizing the progression from renal dysfunction to acute failure following cardiac operation. J Thorac Cardiovasc Surg 1980; 79: 838–844.Google Scholar
Hanna EL, Kilburg H, O'Donel JF, Lukacit G, Shields EP. Adult open heart hospital mortality rates. JAMA 1990; 264: 2768–2774.Google Scholar
Mazzarella V, Gallucci T, Tozzo C, et al. Renal function in patients undergoing cardiopulmonary bypass operations. J Thorac Cardiovasc Surg 1992; 104: 1625–1627.Google Scholar
Hilberman M, Myers BD, Carrie BJ, Derby G, Jamilsosn RL, Stinson EB. Acute renal failure following cardiac surgery. J Thorac Cardiovasc Surg 1979; 77: 880–888.Google Scholar
Hou SH, Bushinsky DA, Wish JB, Cohen JJ, Harrington JT. Hospital-acquired renal insufficiency. A prospective study. Am J Med 1983; 74: 243–248.Google Scholar
Rao V, Ivanof J, Welser RD, Christakis GT, David TE. Predictors of low cardiac output syndrome after coronary artery bypass. J Thorac Cardiovasc Surg 1996; 112: 38–51.Google Scholar
Badner NH, Murkin JM, Lok P. Differences in pH management and pulsatile/non-pulsatile perfusion during cardiopulmonary bypass do not influence renal function. Anesth Analg 1992; 75: 606–701.Google Scholar
Louagie YA, Gonzalez M, Collard E, et al. Does flow character of cardiopulmonary bypass make a difference? J Thorac Cardiovasc Surg 1992; 104: 1628–1638.Google Scholar
Urzua J, Troncosco S, Bugedo G, et al. Renal function and cardiopulmonary bypass: effects of perfusion pressure. J Cardiovasc Anaesth 1992; 6: 309–312.Google Scholar
Bucci M, D'Ambrosio G, Cascino P, Pace Palatti V, Martines G. Modificazioni della funzionalita renale in soggetti sottoposti a by-pass aorto-coronarico in circolazione extracorporea. Rev Eur Sci Med Farmacol 1995; 17: 183–190.Google Scholar
Christensen EI, Rennke HG, Carone FA. Renal tubular uptake of protein: effects of molecular charge. Am J Physiol 1983; 244: F436–441.Google Scholar
Caliskan S, Hacibekiroglu M, Sever L, Ozbory G, Arisoy N. Urinary N-acetyl-beta-d-glucosaminidase. Nephron 1996; 74: 401–404.Google Scholar
Everaert K, Delanghe J, Vande Wiele C, et al. Urinary alpha 1-microglobulin detects uropathy. A prospective study in 483 urological patients. Clin Chem Lab Med 1998; 36: 309–315.Google Scholar
Loeb WF. The measurements of renal injury. Toxicol Pathol 1998; 26: 26–28.Google Scholar
Dehne MG, Boldt J, Heise D, Sablotzki A, Hempelmann G. Protein, α1- und β2 Mikroglobulin als Nierenfunktionsmarker in der Herzchirurgie. Anaesthesist 1995; 44: 545–551.Google Scholar
Yokono S, Veki M, Wakano M, et al. Urinary excretion of ulinastin and NAG after cardiopulmonary bypass. Masui 1997; 46: 388–392.Google Scholar
Ascione R, Lloyd CT, Underwood MJ, Gomes WJ, Angelini GD. On-pump versus off-pump coronary revascularization: evaluation of renal function. Ann Thorac Surg 1999; 68: 493–498.Google Scholar
Agihasli M, Raadhakrishmamuthy B, Jiang K, Bao W, Berenson GS. Urinary N-acetyl-d-glucosaminidase changes in relation to age, sex, race and diastolic and systolic blood pressure in a young biracial population. The Bogalusa Heart Study. Am J Hypertens 1996; 9: 157–161.Google Scholar
Skrha J, Haas T, Sperl M, et al. A six-year follow-up: the relationship between N-acetyl-beta-glucosaminidase and albuminuria in relation to retinopathy. Diabetic Med 1991; 8: 817–821.Google Scholar
Galanti LM, Jamart J, Dell'Omo J, Docrier J. Comparison of urinary excretion of albumin, alpha 1-microglobulin and retinol-binding proteins in diabetic patients. Diabetes Metab 1996; 22: 324–330.Google Scholar
Kanwar YS, Liu ZZ, Kashihara W, Waltner EI. Current status of the structural and functional basis of glomerular filtration and proteinuria. Semin Nephrol 1991; 11: 390–413.Google Scholar
Scandling JD, Black VM, Deen WM, et al. Glomerular perm-selectivity in healthy and nephrotic humans. Adv Nephrol 1992; 21: 159–176.Google Scholar
Fujigaki Y, Nagase M, Kobayasi S, Hidaka S, Shimomura M, Hishida A. Intra-GBM side of the functional filtration barrier for endogenous proteins in rats. Kidney Int 1993; 43: 567–574.Google Scholar
Jung K, Becker S. Multiple forms of N-acetyl-d-beta-glucosaminidase of human urine: isolation, properties and the development of a practical approach of differentiation. Biomed Biochim Acta 1991; 50: 861–867.Google Scholar
Brezis M, Rosen S, Silva P, Epstein FH. Renal ischemia: a new prospective. Kidney Int 1984; 26: 375–383.Google Scholar
Ranucci M, Pavesi M, Mazza E, et al. Risk factors for renal dysfunction after coronary surgery: the role of cardiopulmonary bypass technique. Perfusion 1994; 9: 19–26.Google Scholar
Wesselink RMJ, de Boer A, Morshuis WJ, Leusink JA. Cardio-pulmonary bypass time has important influence on mortality and morbidity. Eur J Cardiothorac Surg 1997; 11: 1141–1145.Google Scholar
Christenson JT, Schmuziger M, Maurice J, Simonet F, Velebit V. How safe is coronary bypass surgery in the elderly patients? Analysis of 111 patients aged 75 years or more and 2939 patients younger than 75 years undergoing coronary artery bypass grafting in a private hospital. Coron Artery Dis 1994; 5: 169–174.Google Scholar
Lazar HL, Fitzgerald C, Gross S, Heeren T, Aldea GS, Shemin RJ. Determinants of length of stay after coronary artery bypass graft surgery. Circulation 1995; 92 (Suppl 9): P1120–1124.Google Scholar
Mangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Herskowitz A, Mangano DT. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. The Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med 1998; 128: 194–203.Google Scholar