Simão Antônio Felipe Leite, Meneses Gdayllon Cavalcante, Cezar Lia Cavalcante, Araújo Letícia Machado de, Martins Alice Maria Costa, Lobo Filho Heraldo Guedis, Martins Bruna Viana Barroso, Silva Júnior Geraldo Bezerra da, Daher Elizabeth De Francesco, Lobo Filho José Glauco
Universidade Federal do Ceará, Hospital Universitário Walter Cantidio, Fortaleza, CE, Brazil.
Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE, Brazil.
J Bras Nefrol. 2025 Jul-Sep;47(3):e20240173. doi: 10.1590/2175-8239-JBN-2024-0173en.
Cardiopulmonary bypass (CPB) for coronary artery bypass grafting (CABG) often causes kidney dysfunction and increases morbidity and mortality.
To evaluate the effects of CPB on kidney structures of patients submitted to CABG using serum and urinary biomarkers.
This prospective study included patients who underwent CABG over a 14-month period. Data related to clinical, surgical, and laboratory were collected. The glomerular filtration rate was estimated using the CKD-EPI equation. The urinary biomarkers trialed were nephrin, KIM-1, MCP-1, Syndecan-1, and NGAL.
Out of 30 patients enrolled, 22 were assessed. The mean age was 65 years and most were male. During CABG, the On-pump group had increased urinary nephrin (p = 0.007) and urinary (p = 0.036) and serum NGAL (p = 0.030) levels compared to the Off-pump group. Moreover, intraoperatively, in the On-Pump clusters, the urinary NGAL was correlated with the decrease of glomerular filtration rate in the first 48 hours after CABG (Rho = - 0.838, p = 0.009). There was no statistical difference in clinical and surgical aspects between groups according to use of CBP during CABG.
CBP procedure used during CABG was associated with relevant effects on kidney structure, such as podocyte and tubular injury. Urinary NGAL was able to predict an impairment of glomerular filtration 48 hours after CABG.
冠状动脉旁路移植术（CABG）中的体外循环（CPB）常导致肾功能障碍，并增加发病率和死亡率。
使用血清和尿液生物标志物评估CPB对接受CABG患者肾脏结构的影响。
这项前瞻性研究纳入了在14个月期间接受CABG的患者。收集了与临床、手术和实验室相关的数据。使用CKD-EPI方程估算肾小球滤过率。所检测的尿液生物标志物包括nephrin、KIM-1、MCP-1、Syndecan-1和NGAL。
在纳入的30例患者中，对22例进行了评估。平均年龄为65岁，大多数为男性。在CABG期间，与非体外循环组相比，体外循环组的尿nephrin（p = 0.007）、尿（p = 0.036）和血清NGAL（p = 0.030）水平升高。此外，术中在体外循环组中，尿NGAL与CABG后最初48小时内肾小球滤过率的降低相关（Rho = - 0.838，p = 0.009）。根据CABG期间是否使用CPB，两组在临床和手术方面无统计学差异。
CABG期间使用的CPB程序与对肾脏结构的相关影响有关，如足细胞和肾小管损伤。尿NGAL能够预测CABG后48小时的肾小球滤过功能损害。
