Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York.
Anesthesiology. 2024 Jul 1;141(1):151-158. doi: 10.1097/ALN.0000000000004993.
Acute renal dysfunction and subsequent acute renal failure after cardiac surgery are associated with high mortality and morbidity. Early therapeutic or preventive intervention is hampered by the lack of an early biomarker for acute renal injury. Recent studies showed that urinary neutrophil gelatinase-associated lipocalin (NGAL or lipocalin 2) is upregulated early (within 1 to 3 h) after murine renal injury and in pediatric acute renal dysfunction after cardiac surgery. The authors hypothesized that postoperative urinary NGAL concentrations are increased in adult patients developing acute renal dysfunction after cardiac surgery compared with patients without acute renal dysfunction.
After institutional review board approval, 81 cardiac surgical patients were prospectively studied. Urine samples were collected immediately before incision and at various time intervals after surgery for NGAL analysis by quantitative immunoblotting. Acute renal dysfunction was defined as peak postoperative serum creatinine increase by 50% or greater compared with preoperative serum creatinine.
Sixteen of 81 patients (20%) developed postoperative acute renal dysfunction, and the mean urinary NGAL concentrations in patients who developed acute renal dysfunction were significantly higher early after surgery (after 1 h, mean ± SD, 4,195 ± 6,520 vs. 1,068 ± 2,129 ng/ml; P < 0.01) compared with patients who did not develop acute renal dysfunction. Mean urinary NGAL concentrations continued to increase and remained significantly higher at 3 and 18 h after cardiac surgery in patients with acute renal dysfunction. In contrast, urinary NGAL in patients without acute renal dysfunction decreased rapidly after cardiac surgery.
Patients developing postoperative acute renal dysfunction had significantly higher urinary NGAL concentrations early after cardiac surgery. Urinary NGAL may therefore be a useful early biomarker of acute renal dysfunction after cardiac surgery. These findings may facilitate the early detection of acute renal injury and potentially prevent progression to acute renal failure.
心脏手术后急性肾功能障碍和随后的急性肾衰竭与高死亡率和发病率相关。由于缺乏急性肾损伤的早期生物标志物，早期治疗或预防干预受到阻碍。最近的研究表明，尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL 或脂质运载蛋白 2）在鼠肾损伤后早期（1 至 3 小时内）和儿科心脏手术后急性肾功能障碍中上调。作者假设与没有急性肾功能障碍的患者相比，心脏手术后发生急性肾功能障碍的成年患者术后尿 NGAL 浓度升高。
在机构审查委员会批准后，前瞻性研究了 81 例心脏外科患者。在切开前和手术后不同时间点采集尿液样本，通过定量免疫印迹法分析 NGAL。急性肾功能障碍定义为与术前血清肌酐相比，术后血清肌酐峰值增加 50%或以上。
81 例患者中有 16 例（20%）发生术后急性肾功能障碍，发生急性肾功能障碍的患者术后早期尿 NGAL 浓度明显升高（术后 1 小时，平均值±标准差，4195±6520 与 1068±2129ng/ml；P<0.01）与未发生急性肾功能障碍的患者相比。在发生急性肾功能障碍的患者中，尿 NGAL 浓度继续升高，在心脏手术后 3 和 18 小时仍显著升高。相比之下，在没有急性肾功能障碍的患者中，尿 NGAL 在心脏手术后迅速下降。
术后发生急性肾功能障碍的患者在心脏手术后早期尿 NGAL 浓度明显升高。因此，尿 NGAL 可能是心脏手术后急性肾功能障碍的有用早期生物标志物。这些发现可能有助于早期发现急性肾损伤，并有可能防止进展为急性肾衰竭。
