المؤلفون: Silberstein, Jonathan L., Sprenkle, Preston C., Su, Daniel, Power, Nicholas E., Tarin, Tatum V., Ezell, Paula, Sjoberg, Daniel D., Feifer, Andrew, Fleisher, Martin, Russo, Paul, Touijer, Karim A.

المصدر: BJU International; Aug2013, Vol. 112 Issue 4, p517-525, 9p, 1 Color Photograph, 1 Diagram, 4 Charts, 2 Graphs

مصطلحات موضوعية: NEUTROPHILS, LIPOCALINS, ISCHEMIA, KIDNEY injuries, LABORATORY swine, LAPAROSCOPIC surgery, PNEUMOPERITONEUM, SURGICAL complications

مستخلص: Objectives To test a novel porcine two-kidney model for evaluating the effect of controlled acute kidney injury ( AKI) related to induced unilateral ischaemia on both renal units ( RUs), To use neutrophil gelatinase-associated lipocalin ( NGAL) and physiological serum and urinary markers to assess AKI and renal function., Methods Twelve female Yorkshire pigs had bilateral cutaneous ureterostomies placed laparoscopically with identical duration of pneumoperitoneum for all cases., An experimental group ( n = 9) underwent induced unilateral renal ischaemia with left hilar clamping of timed duration (15, 30, 60 min) and a control group ( n = 3) had no induced renal ischaemia., Urine was collected and analysed from each RU to assess creatinine and NGAL concentration preoperatively and at multiple postoperative time points. Serum was collected and analysed daily for creatinine and NGAL levels., Statistical comparisons were made using the rank-sum and sign-rank tests., Results Three pigs were excluded because of intra-operative and postoperative complications., In the RUs that experienced renal ischaemia ( n = 7),the median urine volume was lower ( P = 0.04) at 6, 12, 24 and 48 h and the median NGAL concentration was higher ( P = 0.04) at 12 and 48 h compared with the RUs of control pigs that experienced no renal ischaemia ( n = 2)., When comparing the ischaemic (left) RU of the pigs in the experimental group with their contralateral non-ischaemic (right) RU, ischaemic RUs had a lower median cumulative urine volume at 6, 12, 24 and 48 h ( P = 0.05) and a higher median NGAL concentration at 12, 24 and 48 h ( P < 0.05)., At 48 h, no significant increase was found in serum NGAL in pigs in the experimental group compared with controls ( P = 0.2)., Creatinine clearance ( CC) was lower in ischaemic RUs compared with non-ischaemic RUs 1 day after surgery ( P = 0.04) with decreasing CC as the duration of ischaemia increased., Conclusions We have developed a promising novel small-scale pilot surgical model that allowed the evaluation of bilateral RU function separately during and after unilateral renal ischaemia., The induction of unilateral renal ischaemia corresponds with physiological changes in both the ischaemic and contralateral RU., AKI as measured by increases in NGAL and decreased renal function as measured by decreases in CC, are specific to the RU exposed to ischaemia. [ABSTRACT FROM AUTHOR]

: Copyright of BJU International is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Sprenkle, Preston C., Wren, James, Maschino, Alexandra C., Feifer, Andrew, Power, Nicholas, Ghoneim, Tarek, Sternberg, Itay, Fleisher, Martin, Russo, Paul

المصدر: Journal of Urology; Jul2013, Vol. 190 Issue 1, p159-164, 6p

مستخلص: Purpose: We evaluated urine NGAL as a marker of acute kidney injury in patients undergoing partial nephrectomy. We sought to identify the preoperative clinical features and surgical factors during partial nephrectomy that are associated with renal injury, as measured by increased urine NGAL vs controls. Materials and Methods: Using patients treated with radical nephrectomy or thoracic surgery as controls, we prospectively collected and analyzed urine and serum samples from patients treated with partial or radical nephrectomy, or thoracic surgery between April 2010 and April 2012. Urine was collected preoperatively and at multiple time points postoperatively. Differences in urine NGAL levels were analyzed among the 3 surgical groups using a generalized estimating equation model. The partial nephrectomy group was subdivided based on a preoperative estimated glomerular filtration rate of less than 60, or 60 ml/minute/1.73 m² or greater. Results: Of 162 patients included in final analysis more than 65% had cardiovascular disease. The median estimated glomerular filtration rate was greater than 60 ml/minute/1.73 m² in the radical and partial nephrectomy, and thoracic surgery groups (61, 78 and 84.5 ml/minute/1.73 m², respectively). Preoperatively, a 10 unit increase in the estimated glomerular filtration rate was associated with a 4 unit decrease in urine NGAL in the partial nephrectomy group. Postoperatively, urine NGAL in the partial nephrectomy group was not higher than in controls and did not correlate with ischemia time. Patients with partial nephrectomy with a preoperative estimated glomerular filtration rate of less than 60 ml/minute/1.73 m² had higher urine NGAL postoperatively than those with a higher preoperative estimated rate. Conclusions: Urine NGAL does not appear to be a useful marker for detecting renal injury in healthy patients treated with partial nephrectomy. However, patients with poorer preoperative renal function have higher baseline urine levels and appear more susceptible to acute kidney injury, as detected by urine levels and Acute Kidney Injury Network criteria, than those with a normal estimated glomerular filtration rate. [Copyright &y& Elsevier]

: Copyright of Journal of Urology is the property of Wolters Kluwer UK and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)