640 Urinary Markers for Acute Tubular Injury Following Paediatric Cardiopulmonary Bypass

• Published in: Pediatric research Vol. 68; no. Suppl 1; p. 327
• Main Authors: Romero, Alcaraz A J, Carcedo, Tesorero G, Villaescusa, Urbano J, Prieto, Botrán M, Román, Romero C, Figueruelo, García A, Cortés, González R
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.11.2010
• Subjects: Medicine; Medicine & Public Health; Pediatric Surgery; Pediatrics
• ISSN: 0031-3998; 1530-0447
• DOI: 10.1203/00006450-201011001-00640

Background and aims: Cardiopulmonary bypass (CPB) has proved to alter organs functions. The aim of this study was to evaluate the reliability of urinary biomarkers when diagnosing acute kidney injury (AKI) after CBP. Methods: Prospective, observational study. Paediatric patients who underwent CPB were included during a 4 month period. Surgical aggression was related to aortic cross-clamp (ACC), circulatory arrest, severe hypothermia and CPB duration. Postoperative AKI was based on serum creatinine (Cr) elevation by 50% from baseline or need of dialysis. Cystatin C (CyC), N-acetylb- glucosaminidase (NAG) and a1-microglobulin (a1mg) urinary values and plasmatic CyC were analysed using fractional excretion of CyC (FEcc), NAG/Cr ratio (normal 15 U/g Cr) and a1mg/Cr ratio (normal 0.1 - 14 mg/g Cr). Data presented as median (P25-P75). Results: 31 patients were included. Median age was 10 months (4-78 months). 11 children presented postoperative AKI. 29 patients showed increased excretion of NAG, median 51.0 (23.8- 73.8 UI/g Cr). a1mg/cr values were elevated in all children, median 172.9 (70.6-392.9 mg/g Cr). a1mg and FEcc values were higher amongst children presenting AKI (0.14%, 330 mg/g Cr vs 0.06%, 96 mg/g Cr, P < 0.02). In this group CPB duration and ACC time were also higher (215, 108 vs 156, 77 minutes, P< 0.03). Correlation between FEcc and a1mg/cr as well as between both FEcc and a1mg/ cr and ACC time was found. Conclusions: Tubular injury is frequent amongst children undergoing CBP. Magnitude of surgical aggressions might influence postoperative AKI. FEcc and a1mg/cr could be of use when analysing AKI after CBP.