Kidney Diseases, Lurie Children's Hospital, 225 E Chicago Avenue, Box 37, Chicago, IL, USA.
Pediatr Nephrol. 2013 Jun;28(6):959-62. doi: 10.1007/s00467-012-2395-2. Epub 2013 Jan 13.
Acute kidney injury (AKI) carries a large burden of morbidity and mortality. Early diagnosis may lead to better strategies of clinical care. Cardiac surgery involving cardiopulmonary bypass is associated with a significant incidence of AKI. The study objective was to determine whether or not preoperative fibroblast growth factor-23 (FGF23) levels differed among pediatric patients who did or did not develop AKI following cardiac surgery.
A nested case-control study was performed. FGF23 levels were measured pre- and post-operatively in 19 children without chronic kidney disease (CKD) who underwent cardiopulmonary bypass. Five patients developed AKI and 14 patients served as controls.
FGF23 levels in patients who developed AKI following cardiac surgery were elevated above normal levels, both pre-operatively and post-operatively compared with those patients who did not develop AKI. Relative risk of developing AKI when the pre-operative FGF23 level was >86 RU/mL was 2.0 (p = 0.033). Preoperative FGF23 levels correlated with post-operative fluid gain (correlation coefficient 0.607, p = 0.0059).
FGF23 may serve as a pre-operative prognostic indicator of the development of AKI following cardiopulmonary bypass surgery in pediatric patients without CKD. Identifying patients more likely to have AKI following surgery provides a means of achieving closer clinical management of AKI and fluid balance.
急性肾损伤（AKI）具有很大的发病率和死亡率负担。早期诊断可能会导致更好的临床护理策略。涉及体外循环的心脏手术与 AKI 的发生率显著相关。本研究的目的是确定在接受心脏手术后是否发生 AKI 的儿科患者的术前成纤维细胞生长因子 23（FGF23）水平是否存在差异。
进行了嵌套病例对照研究。在 19 例无慢性肾脏病（CKD）且接受体外循环的儿童中，术前和术后均测量了 FGF23 水平。有 5 例患者发生 AKI，14 例患者作为对照。
与未发生 AKI 的患者相比，接受心脏手术后发生 AKI 的患者的 FGF23 水平术前和术后均高于正常水平。术前 FGF23 水平>86 RU/mL 时发生 AKI 的相对风险为 2.0（p=0.033）。术前 FGF23 水平与术后液体获得量相关（相关系数 0.607，p=0.0059）。
在无 CKD 的儿科患者中，FGF23 可作为体外循环手术后 AKI 发生的术前预后指标。确定术后更有可能发生 AKI 的患者可以实现 AKI 和液体平衡的更密切临床管理。
