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Pattern of renal dysfunction associated with myocardial revascularization surgery and cardiopulmonary bypass

Published online by Cambridge University Press:  11 July 2005

A. Faulí ,
C. Gomar ,
J. M. Campistol ,
L. Alvarez ,
A. M. Manig  and
P. Matute
A. Faulí
Affiliation:
University of Barcelona, Department of Anaesthesiology, Hospital Clinic, Barcelona, Spain
C. Gomar
Affiliation:
University of Barcelona, Department of Anaesthesiology, Hospital Clinic, Barcelona, Spain
J. M. Campistol
Affiliation:
University of Barcelona, Department of Nephrology, Hospital Clinic, Barcelona, Spain
L. Alvarez
Affiliation:
University of Barcelona, Laboratory of Biochemistry, Hospital Clinic, Barcelona, Spain
A. M. Manig
Affiliation:
University of Barcelona, Investigation and Development Board, Hospital Clinic, Barcelona, Spain
P. Matute
Affiliation:
University of Barcelona, Department of Anaesthesiology, Hospital Clinic, Barcelona, Spain
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Summary

Background and objective: A variable incidence rate of renal dysfunction (3–35%) after cardiac surgery with cardiopulmonary bypass has been reported. The aim was to define the typical pattern of renal dysfunction that follows coronary surgery with cardiopulmonary bypass using albumin, immunoglobulin (IgG), α1-microglobulin and β-glucosaminidase (β-NAG) excretion as indicators.

Methods: Twenty patients with preoperative normal renal function, defined by plasma creatinine, creatinine clearance, fractional excretion of sodium and renal excretion of proteins, undergoing elective myocardial revascularization surgery with cardiopulmonary bypass, were prospectively studied. Variables recorded were demographic and haemodynamic variables, duration of cardiopulmonary bypass and aortic clamping, intra- and postoperative urine output, plasma creatinine concentration, creatinine clearance and excretion of sodium, albumin, IgG, β-glucosaminidase (β-NAG), and β-microglobulin. Measurements were made preoperatively, immediately before and then during and immediately after cardiopulmonary bypass, and again at 1, 24, 72 h, 7 and 40 days following surgery.

Results: Albumin and IgG excretion rose significantly during cardiopulmonary bypass (P < 0.05), remaining at these levels at 24 h postoperatively. An increase of α1-microglobulin and β-NAG concentrations was observed during cardiopulmonary bypass (P < 0.05), which were maintained until the seventh postoperative day and remained elevated in some patients at the 40th postoperative day. This correlated with preoperative diabetes mellitus (P < 0.001), low cardiac output after cardiopulmonary bypass (P < 0.001) and the duration of stay in the intensive care unit (P < 0.001).

Conclusions: The pattern of renal dysfunction after cardiopulmonary bypass for myocardial revascularization is characterized by temporary renal dysfunction at both glomerular and tubular levels with an onset within 24 h of surgery and which lasts between 24 h and 40 days, respectively, following surgery.

Keywords

BLOOD PROTEINS, immunoglobulin G, immunoglobulins, serum globulinsCARDIAC SURGICAL PROCEDURES, coronary artery bypass, myocardial revascularizationENZYMES, glucosaminidase, glycoside hydrolases, hexosaminidases, hydrolasesKIDNEY FUNCTION TESTS, glomerular filtration rate, radioisotope renographySURGICAL PROCEDURES, OPERATIVE, cardiopulmonary bypass, extracorporeal circulationUROLOGICAL DISEASES, albuminuria, proteinuria
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 6 , June 2003 , pp. 443 - 450
Copyright
© 2003 European Society of Anaesthesiology

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