Diagnostic Value of Detecting the Level of Serum NGAL for Acute Kidney Injury after Tetralogy of Fallot Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANFang ¹ , ZHANGHui-jun ² , SUZhen-yu ² , LIXiao-bing ² , DONGYan-bo ² , LVYing ² , LIHong-ying ² ,  WANGJun ²

1. Department of Cardiac Surgery, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, P.R.China;
2. Department of Cardiac Surgery, the First Hospital of Hebei Medical University, Shijiazhuang 050031, P.R.China;

Corresponding?author：

WANGJun, Email: fangfangy83@sina.com

Keywords：

Neutrophil gelatinase-associated lipocalin; Acute kidney injury; Tetralogy of Fallot

DOI：

10.7507/1007-4848.20160145

Video：

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Objective To investigate the diagnostic value of serum neutrophil gelatinase-associated lipocalin (NGAL) for early acute kidney injury (AKI) after tetralogy of Fallot (TOF) surgery. Methods We retropectively analyzed the clinical data of 113 patients underwent TOF surgery in our hospital bewteen April 2012 and April 2014. There were 67 males and 46 females at the average age of 8.28±4.75 months ranging from 5 months to 18 months. According to the different clinical manifestation of AKI, those patients were devided into a group A, group B, and group C. In the group A, there were 78 patients with 43 males and 35 females at the mean age of 8.18±3.72 months. In the group B, there were 20 patients with 12 males and 8 females at the mean age of 8.25±1.27 months. In the group C, there were 15 patients with 12 males and 3 females at the mean age of 8.09±2.92 months. We collected the blood in different time before and after the operation. At the same time, we carried on one-way analysis of variance to detect the differences among the three groups. Results There was no statistical difference in the level of serum NGAL among the 3 groups before operation. Compared to pre-operation, there was no statistical difference in the level of serum NGAL among the different time of the group A (P>0.05). There was oliguria and potassium increased in the group B. After strengthening cardiac and lightening heart load, urine volume recovered. There was a transient rise in serum NGAL and the summit is 199.90±49.44 ng/ml at the 8th hour. Compared with that before operation, there was a statistical difference. After 12 hours, the serum NGAL decreased to the normal level. The serum NGAL levle of Group C had constantly increased and there was a statistical difference compared with that before the surgery. After the treatment of peritoneal dialysis, the serum NGAL returned to the normal level. The area under receiver operating characteristic (ROC) curve of serum NGAL in the group C was 0.881 (95%CI:0.73-1.00, P<0.05). Conclusion The detection of serum NGAL level can be valuable for early diagnosis and treatment for AKI after TOF surgery.

Citation： YANFang, ZHANGHui-jun, SUZhen-yu, LIXiao-bing, DONGYan-bo, LVYing, LIHong-ying, WANGJun. Diagnostic Value of Detecting the Level of Serum NGAL for Acute Kidney Injury after Tetralogy of Fallot Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(6): 613-616. doi: 10.7507/1007-4848.20160145 Copy

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2.	Bucerius J, Gummert JF, Walther T, et al. On-pump versus off-pump coronary artery bypass grafting:impact on postoperative renal failure requiring renal replacement therapy. Ann Thorac Surg, 2004, 77(4):1250-1256.
3.	盧琳, 吳錫階, 陳良萬. 腹膜透析治療嬰幼兒復雜先心病術后急性腎功能不全30例. 中華胸心血管外科雜志, 2013, 29(10):588-590.
4.	宮麗. 中性粒細胞明膠酶脂質運載蛋白與急性腎損傷的研究進展. 國際泌尿系統雜志, 2011, 31(1):77-79.
5.	Kuwabara T, Mori K, Mukoyama M, et al. Urinary neutrophil gelatinase-associated lipocalin levels reflect damage to glomeruli, proximal tubules, and distal nephrons. Kidney Int, 2009, 75(3):285-294.
6.	Mishra J, Ma O, Prada A, et al. Identification of neutrophil gelatinaseassociated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol, 2003, 14(10):2534-2543.
7.	Devarajan P. Biomarkers for the early detection of acute kidney injury. Curr Opin Pediatr, 2011, 23(4):194-200.
8.	Chen X, Liu X, Wan X, et al. Ischemic preconditioning attenuates renal ischemia-reperfusion injury by inhibiting activation of IKK beta and inflammatory response. Am J Nephrol, 2009, 30(3):287-294.
9.	Sean MB, Michal B, Michael H, et al. Plasma and urine neutrophil gelatinase-associated lipocalin in septic versus non-septic acute kidney injury in critical illness. Intensive Care Med, 2010, 36(3):452-461.
10.	Cruz DN, Cal M, Garzotto F, et al. Plasma neutrophil gelatinaseassociated lipocalin is an early biomarker for acute kidney injury in an adult ICU population. Intensive care Med, 2010, 36(3):444-451.
11.	Moore E,Bellomo R, Nichol A. Biomarkers of acute kidney injury in anesthesia, intensive care and major surgery:from the bench to clinical research to clinical practice. Minerva Anestesiol, 2010, 76(6):425-440.
12.	Bellomo R, Ronco C, Kellum JA, et al. Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs:the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care, 2004, 8(4):R204-212.
13.	臧芝棟, 黃英姿, 邱海波, 等. 尿中性粒細胞明膠相關脂質運載蛋白和白細胞介素-18對重癥患者急性腎功能損傷的早期診斷價值. 中華內科雜志, 2010, 49(5):396-399.
14.	曹長春, 陳鑫, 穆心葦, 等. 心臟術后尿中性粒細胞明膠酶相關脂質運載蛋白和白細胞介素-18與急性腎損傷的關系. 中華腎臟病雜志, 2008, 24(7):471-474.
15.	Picca S, Ricci Z, Picardo S. Acute kidney injury in an infant after cardiopulmonary bypass. Semin Nephrol, 2008, 28(5):470-476.
16.	Bailey D, Phan V, Litalien C, et al. Risk factors of acute renal failure in critically ill children:A prospective descriptive epidemiological study. Pediatr Crit Care Med, 2007, 8(1):29-35.
17.	Dittrich S, Kurschat K, Dahnert I, et al. Renal function after cardiopulmonary bypass surgery in cyanotic congenital heart disease. Int J Cardiol, 2000, 73(2):173-179.
18.	馬玉國, 趙紅麗, 喬順義, 等. 急性腎功能衰竭患者中性粒細胞明膠酶相關脂質運載蛋白水平與病情危重程度相關性研究. 武警醫學, 2012, 23(7):563-564.
19.	安淑嫻, 臧秀娟, 袁偉杰, 等. 中性粒細胞明膠酶相關脂質運載蛋白對大鼠腎臟缺血再灌注損傷的保護作用及機制. 上海醫學, 2012, 35(9):770-773.
20.	Raff U, Schneider R, Gambaryan S, et al. L-Arginine dose not affect renal morphology and cell survival in ischemic acute renal failure in rats. Nephron Physiol, 2005, 101(3):39-50.

1. 丁文祥, 主編. 小兒心臟外科學. 濟南:山東科學技術出版社. 2000. 370-371.
2. Bucerius J, Gummert JF, Walther T, et al. On-pump versus off-pump coronary artery bypass grafting:impact on postoperative renal failure requiring renal replacement therapy. Ann Thorac Surg, 2004, 77(4):1250-1256.
3. 盧琳, 吳錫階, 陳良萬. 腹膜透析治療嬰幼兒復雜先心病術后急性腎功能不全30例. 中華胸心血管外科雜志, 2013, 29(10):588-590.
4. 宮麗. 中性粒細胞明膠酶脂質運載蛋白與急性腎損傷的研究進展. 國際泌尿系統雜志, 2011, 31(1):77-79.
5. Kuwabara T, Mori K, Mukoyama M, et al. Urinary neutrophil gelatinase-associated lipocalin levels reflect damage to glomeruli, proximal tubules, and distal nephrons. Kidney Int, 2009, 75(3):285-294.
6. Mishra J, Ma O, Prada A, et al. Identification of neutrophil gelatinaseassociated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol, 2003, 14(10):2534-2543.
7. Devarajan P. Biomarkers for the early detection of acute kidney injury. Curr Opin Pediatr, 2011, 23(4):194-200.
8. Chen X, Liu X, Wan X, et al. Ischemic preconditioning attenuates renal ischemia-reperfusion injury by inhibiting activation of IKK beta and inflammatory response. Am J Nephrol, 2009, 30(3):287-294.
9. Sean MB, Michal B, Michael H, et al. Plasma and urine neutrophil gelatinase-associated lipocalin in septic versus non-septic acute kidney injury in critical illness. Intensive Care Med, 2010, 36(3):452-461.
10. Cruz DN, Cal M, Garzotto F, et al. Plasma neutrophil gelatinaseassociated lipocalin is an early biomarker for acute kidney injury in an adult ICU population. Intensive care Med, 2010, 36(3):444-451.
11. Moore E,Bellomo R, Nichol A. Biomarkers of acute kidney injury in anesthesia, intensive care and major surgery:from the bench to clinical research to clinical practice. Minerva Anestesiol, 2010, 76(6):425-440.
12. Bellomo R, Ronco C, Kellum JA, et al. Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs:the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care, 2004, 8(4):R204-212.
13. 臧芝棟, 黃英姿, 邱海波, 等. 尿中性粒細胞明膠相關脂質運載蛋白和白細胞介素-18對重癥患者急性腎功能損傷的早期診斷價值. 中華內科雜志, 2010, 49(5):396-399.
14. 曹長春, 陳鑫, 穆心葦, 等. 心臟術后尿中性粒細胞明膠酶相關脂質運載蛋白和白細胞介素-18與急性腎損傷的關系. 中華腎臟病雜志, 2008, 24(7):471-474.
15. Picca S, Ricci Z, Picardo S. Acute kidney injury in an infant after cardiopulmonary bypass. Semin Nephrol, 2008, 28(5):470-476.
16. Bailey D, Phan V, Litalien C, et al. Risk factors of acute renal failure in critically ill children:A prospective descriptive epidemiological study. Pediatr Crit Care Med, 2007, 8(1):29-35.
17. Dittrich S, Kurschat K, Dahnert I, et al. Renal function after cardiopulmonary bypass surgery in cyanotic congenital heart disease. Int J Cardiol, 2000, 73(2):173-179.
18. 馬玉國, 趙紅麗, 喬順義, 等. 急性腎功能衰竭患者中性粒細胞明膠酶相關脂質運載蛋白水平與病情危重程度相關性研究. 武警醫學, 2012, 23(7):563-564.
19. 安淑嫻, 臧秀娟, 袁偉杰, 等. 中性粒細胞明膠酶相關脂質運載蛋白對大鼠腎臟缺血再灌注損傷的保護作用及機制. 上海醫學, 2012, 35(9):770-773.
20. Raff U, Schneider R, Gambaryan S, et al. L-Arginine dose not affect renal morphology and cell survival in ischemic acute renal failure in rats. Nephron Physiol, 2005, 101(3):39-50.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Diagnostic Value of Detecting the Level of Serum NGAL for Acute Kidney Injury after Tetralogy of Fallot Surgery

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