Laboratory Medicine Operative Unit 1 - Clinical Pathology, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy.
Intensive Care Unit, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy.
Biochem Med (Zagreb). 2018 Feb 15;28(1):010904. doi: 10.11613/BM.2018.010904. Epub 2018 Jan 10.
Acute kidney injury (AKI) occurs frequently after abdominal aortic surgery and there is currently no effective marker able to detect early onset. The aim of this study is to evaluate the ability of neutrophil gelatinase-associated lipocalin (NGAL) to early identify the development of acute renal damage in patients undergoing endovascular aneurysm repair (EVAR) or open aortic repair (OAR).
Serial samples of blood and urine were obtained from 25 patients undergoing both EVAR and OAR. Seven male subjects with AKI and 18 subjects with no-AKI (17 males, 1 female) were included in the study. We determined concentrations of serum creatinine (sCr) and urinary, serum and whole blood NGAL (uNGAL, sNGAL, bNGAL) collected at baseline, and after 4 and 18 hours. AKI was defined according to the RIFLE criteria (risk, injury, failure, loss of kidney function, and end-stage kidney disease): increase by 50% in sCr or reduction of at least 25% of estimated glomerular filtration rate (eGFR) from baseline.
Seven patients developed AKI in the stage Risk. There was no significant difference in sNGAL concentrations in the AKI group as compared to no-AKI group. However, the uNGAL/uCreatinine ratio and bNGAL concentrations were significantly higher after 18 hours in the AKI group (no-AKI 1.69 (0.91 - 2.47) AKI 3.2 (2.08 - 5.92) ng/mg for uNGAL/uCreatinine ratio, P = 0.036; and no-AKI 83 (59 - 131) vs AKI 164 (126 - 263) ng/mL for bNGAL, P = 0.029).
Our results suggest that uNGAL, sNGAL and bNGAL, after abdominal aortic surgery, are not suitable as early biomarkers of AKI.
急性肾损伤（AKI）在腹主动脉手术后经常发生，目前尚无能够早期检测到的有效标志物。本研究旨在评估中性粒细胞明胶酶相关脂质运载蛋白（NGAL）检测接受血管内腹主动脉瘤修复（EVAR）或开放主动脉修复（OAR）的患者发生急性肾损伤的能力。
本研究纳入 25 例行 EVAR 和 OAR 的患者，采集其血、尿标本。7 例 AKI 患者和 18 例非 AKI 患者（17 名男性，1 名女性）入选本研究。检测基线、术后 4 小时和 18 小时的血肌酐（sCr）浓度，以及尿、血清和全血 NGAL（uNGAL、sNGAL、bNGAL）浓度。AKI 根据 RIFLE 标准（风险、损伤、衰竭、肾功能丧失和终末期肾病）定义：sCr 增加 50%或肾小球滤过率（eGFR）至少降低 25%。
7 例患者进展为 RISK 期 AKI。AKI 组和非 AKI 组的 sNGAL 浓度无显著差异。然而，18 小时时 AKI 组的 uNGAL/uCr 比值和 bNGAL 浓度显著升高（非 AKI 1.69（0.91-2.47）vs AKI 3.2（2.08-5.92）ng/mg，P=0.036；非 AKI 83（59-131）vs AKI 164（126-263）ng/mL，P=0.029）。
本研究结果表明，腹主动脉手术后，uNGAL、sNGAL 和 bNGAL 不适合作为 AKI 的早期生物标志物。
