Warning signs predict kidney injury after surgery

Acute kidney injury (AKI) is a common – but preventable -- complication after surgery that can lead to other complications or even death. The use and development of biomarkers will help physicians diagnose and treat acute kidney injury. Three protein measurements indicate who has a high risk of developing kidney injury after heart surgery, according to two studies appearing in an upcoming issue of the Journal of the American Society of Nephrology.

"To date, these are the largest studies in adults and children comparing and validating the performance of three of the most frequently studied markers of kidney injury," said author Chirag Parikh, MD, PhD (Yale University School of Medicine).

The studies included more than 1,200 adults and 300 children undergoing heart throughout North America. Frequent urine and blood samples were collected to measure levels of three proteins -- urine interleukin-18 (IL-18) and urine and plasma (blood) neutrophil gelatinase-associated lipocalin (NGAL)—and assess their ability to predict who will develop kidney injury after surgery.

Traditionally, kidney trouble is assessed by measuring the blood protein creatinine, which is not ideal because it has a delayed result—it does not pick up early damage and injury to the kidneys.

"We demonstrated that the three proteins in our study identify kidney injury soon after surgery and 24 to 48 hours earlier than creatinine, and shows a similar result," according to Parikh.

Risk of kidney injury was especially high—more than six times higher—for adults and children with the highest levels of urine IL-18. Plasma NGAL also predicted kidney injury in adults, whereas urine NGAL was not an accurate predictor in adults once results were adjusted for other factors. Urine IL-18 and urine, but not plasma, NGAL were accurate predictors in children.

Doctors may wish to measure these or blood proteins immediately after surgery to predict which patients are at high risk of developing . These patients might benefit from kidney protective therapies.

The studies' results could also transform the diagnosis of kidney disease, Parikh believes. "Developing markers of structural kidney damage, before kidney function fails, is a top priority," he said.

The research's main limitation was that the adults enrolled were mainly Caucasian. Future studies should consider whether the results are the same in other races.

More information: -- "Postoperative Biomarkers Predict Acute Kidney Injury and Poor Outcomes after Adult Cardiac Surgery", doi:10.1681/ASN.2010121302
-- "Postoperative Biomarkers Predict Acute Kidney Injury and Poor Outcomes after Pediatric Cardiac Surgery", doi:10.1681/ASN.2010111163

add to favorites email to friend print save as pdf

Related Stories

New lab test predicts risk of kidney injury after surgery

Mar 12, 2008

A simple laboratory test may provide a new way for doctors to identify patients at risk of developing potentially severe acute kidney injury (AKI) after surgery—up to three days before the problem would otherwise be detected, ...

New lab test helps predict kidney damage

Jul 24, 2009

Acute kidney injury (AKI) is a frequent complication in patients in intensive care. A new laboratory test called urine neutrophil gelatinase associated lipocalin (NGAL) helps predict if patients will develop acute kidney ...

Seeing kidney injury, as it happens

Jan 31, 2011

The current check for kidney disease is a simple blood test for serum creatinine, but it can take longer than two days for this metabolite to accumulate to levels that are significant enough to indicate kidney damage - and ...

Recommended for you

Medtronic spends $350M on another European deal

13 hours ago

U.S. medical device maker Medtronic is building stronger ties to Europe, a couple months after announcing a $42.9 billion acquisition that involves moving its main executive offices across the Atlantic, where it can get a ...

Mind over matter for people with disabilities

Aug 26, 2014

People with serious physical disabilities are unable to do the everyday things that most of us take for granted despite having the will – and the brainpower – to do so. This is changing thanks to European ...

Ukraine's former world's tallest man dies

Aug 25, 2014

Ukraine's tallest man, who briefly held the world record but gave it up to live as a recluse, has died due to complications from the condition that saw him never stop growing, local media reported Monday.

User comments