TUBULAR NEPHROTOXICITY AFTER CARDIAC-SURGERY UTILIZING CARDIOPULMONARY BYPASS

被引:31
作者
WESTHUYZEN, J
MCGIFFIN, DC
MCCARTHY, J
FLEMING, SJ
机构
[1] ROYAL BRISBANE HOSP,DEPT RENAL MED,BRISBANE,QLD 4029,AUSTRALIA
[2] PRINCE CHARLES HOSP,BRISBANE,QLD 4032,AUSTRALIA
关键词
CARDIAC SURGERY; CARDIOPULMONARY BYPASS; CREATININE CLEARANCE; KIDNEY FUNCTION TESTS; KIDNEY FAILURE; TUBULAR MARKERS; URINE;
D O I
10.1016/0009-8981(94)90283-6
中图分类号
R446 [实验室诊断]; R-33 [实验医学、医学实验];
学科分类号
1001 ;
摘要
Markers of renal tubular injury were examined in 21 patients (16 male, 5 female, mean age 57.4 years) undergoing cardiac surgery utilising cardiopulmonary bypass. Postoperative urine outputs were very high (200-250 ml/h at 1-2 h), decreasing to 100 ml/h by 6 h. Although creatinine clearances did not vary significantly in the postoperative period (P = 0.16), significant changes were noted in the urinary concentrations of three tubular markers relative to creatinine concentration (P < 0.001). Urinary Pz-microglobulin increased from negligible levels (median 0.01 mg/mmol creatinine) to peak at 4 h (median 4.55 mg/mmol), in part due to interference with its reabsorption by the plasma volume expander Haemaccel. Concentrations of the brush border antigen adenosine deaminase binding protein increased 6-fold, from a median of 5.03 arbitrary units (AU)/mu mol to 31.2 AU/mu mol at 48 h. The lysosomal enzyme N-acetyl-beta-D-glucosaminidase increased nearly 4-fold, from 0.68 units/mmol to 2.64 units/ mmol at 48 h. Our results suggest that cardiac surgery utilising cardiopulmonary bypass is associated with acute tubular injury which can occur in the absence of overt changes in creatinine clearance.
引用
收藏
页码:123 / 132
页数:10
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