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Acute kidney injury is a frequent complication after cardiac surgery with cardiopulmonary bypass in infants. Neutrophil gelatinase-associated lipocalin has been suggested to be a promising early biomarker of impending acute kidney injury. On the other hand, neutrophil gelatinase-associated lipocalin has been shown to be elevated in systemic inflammatory diseases without renal impairment. In this secondary analysis of data from our previous study on acute kidney injury after infant cardiac surgery, our hypothesis was that neutrophil gelatinase-associated lipocalin may be associated with surgery-related inflammation.
We prospectively enrolled 59 neonates and infants undergoing cardiopulmonary bypass surgery for CHD and measured neutrophil gelatinase-associated lipocalin in plasma and urine and interleukin-6 in the plasma. Values were correlated with postoperative acute kidney injury according to the paediatric Renal-Injury-Failure-Loss-Endstage classification.
Overall, 48% (28/59) of patients developed acute kidney injury. Of these, 50% (14/28) were classified as injury and 11% (3/28) received renal replacement therapy. Both plasma and urinary neutrophil gelatinase-associated lipocalin values were not correlated with acute kidney injury occurrence. Plasma neutrophil gelatinase-associated lipocalin showed a strong correlation with interleukin-6. Urinary neutrophil gelatinase-associated lipocalin values correlated with cardiopulmonary bypass time.
Our results suggest that plasma and urinary neutrophil gelatinase-associated lipocalin values are not reliable indicators of impending acute kidney injury in neonates and infants after cardiac surgery with cardiopulmonary bypass. Inflammation may have a major impact on plasma neutrophil gelatinase-associated lipocalin values in infant cardiac surgery. Urinary neutrophil gelatinase-associated lipocalin may add little prognostic value over cardiopulmonary bypass time.
The climate of Europe has changed in the past century. An increase in mean annual air temperature of +0.90°C could be observed between 1901 and 2005 (Jones & Moberg 2003). For the period 1977–2000, trends are even higher for Europe's mountain regions (Böhm et al. 2001). Beniston (2005) showed that for the alpine region minimum temperatures have increased up to 2 °C during the twentieth century, whereas the snow cover period has been reduced (IPCC 2007). The alpine and nival (uppermost altitudinal zone of the Alps above the closed alpine grassland) zones (e.g., Grabherr 1997) of high mountain ecosystems are considered to be particularly sensitive to warming (Diaz & Bradley 1997; Haeberli & Beniston 1998) as these ecosystems are determined by low temperature conditions. This life zone offers ideal conditions to study climate change effects because (1) direct human impact is very low, (2) its ecological systems are comparatively simple, at least in the upper elevation levels, and (3) its systems are dominated by abiotic, climate-related ecological factors. The importance of biotic factors such as competition decreases with altitude (Körner 1994; Callaway et al. 2002). Since high mountain plants have proven to respond sensitively to climate change (Grabherr et al. 1994, 2001), great efforts were made to establish the large-scale monitoring network GLORIA (Global Observation Research Initiative in Alpine environments) (Pauli et al. 2003).
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