Very Transient Cases of Acute Kidney Injury in the Early Postoperative Period After Cardiac Surgery: The Relevance of More Frequent Serum Creatinine Assessment and Concomitant Urinary Biochemistry Evaluation

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• 作者：Alexandre Toledo Maciel ; MD^* ; ^&dagger ; ; ^&Dagger ; ; ^{alexandre.toledo@imedgroup.com.br" class="auth_mail" title="E-mail the corresponding author} ; Antonio Paulo Nassar Jr ; MD^* ; ^§ ; ; Daniel Vitorio ; MD^* ; ^&dagger ;
• 关键词：cardiac surgery ; acute kidney injury ; urine biochemistry ; very transient physicochemical approach
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：30
• 期：1
• 页码：56-63
• 全文大小：407 K

文摘

To evaluate if more frequent serum creatinine (sCr) measurements in the early postoperative period (first 48 hours) after cardiac surgery would help in early diagnosis of acute kidney injury (AKI), as well as reveal cases of AKI duration of fewer than 24 hours (vtAKI). The sequential blood and urinary biochemical profile of patients who developed vtAKI was compared with that of the patients who did not develop AKI or who developed AKI for more than 48 hours (pAKI).

Design

A retrospective analysis of prospectively collected data.

Setting

Two intensive care units of 2 private hospitals.

Participants

Twenty-nine patients who underwent cardiac surgery who had 6 values of serum creatinine (sCr) measured within the first 48 hours after surgery and concomitant spot urine samples for urine biochemistry assessment.

Interventions

None.

Measurements and Main Results

Eighteen patients (62%) developed Acute Kidney Injury Network (AKIN) sCr-based AKI, half of them for fewer than 24 hours. Most AKI patients had the sCr increase diagnosed 6 to 12 hours after surgery. When comparing the sequential alterations of blood and urinary parameters among patients with no AKI, vtAKI, and pAKI, the authors found that most of them were similar among groups, differing only in magnitude and duration.

Conclusions

More frequent sCr measurements in the early postoperative period, together with urine biochemistry assessment, have the potential to anticipate AKI diagnosis after cardiac surgery and reveal cases of very transient AKI usually not diagnosed in current practice. The clinical relevance of these findings must be evaluated in larger, prospective studies.