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Acute Kidney Injury After Cardiac Surgery

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Cardio-Nephrology

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Abstract

Cardiac surgery remains one of the most common high-risk surgeries in the world. Acute kidney injury (AKI) is one of the most frequent and serious complications to occur following cardiac surgery, with an incidence ranging from 5 to 40% depending on specific definition of AKI, the preoperative renal status of the patient, and the type of surgery. Although postoperative AKI requiring dialysis is rare, it is independently associated with mortality, and the risk of mortality is high in these patients, averaging around 60–70%. The pathogenesis of AKI in cardiac surgery is complex and multifactorial, and results from mechanisms that can cause injury during the preoperative, intraoperative, and postoperative phases. Risk factors for AKI include preoperative (patient-related) risk factors (e.g., female gender, reduced left ventricular ejection fraction, congestive heart failure, advanced age, diabetes) and perioperative (procedure-related) factors (e.g., off-pump vs on-pump surgery, duration of cardiopulmonary bypass, hypothermia, volume status, anemia, hemodilution). The diagnosis of cardiac surgery associated AKI relies mainly on biomarkers, and serum creatinine remains the most important biomarker routinely used since no suitable substitute that is equally as feasible and inexpensive has been identified to date. However, the detective ability of serum creatinine is low, and its response to renal insult is slow and late. We discuss here new biomarkers for the detection of post-cardiac surgery AKI, including cystatin C, interleukin (IL)-18, L-type fatty acid-binding protein, and neutrophil gelatinase-associated lipocalin. We discuss options for pharmacological renal protection to prevent post-cardiac surgery AKI.

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Abbreviations

ACE inhibitor:

Angiotensin-converting enzyme inhibitors

AKI:

Acute kidney injury

AKIN:

Acute kidney injury network

ATP:

Adenosine triphosphate

CABG:

Coronary artery bypass graft

CPB:

Cardiopulmonary bypass

CSA-AKI:

Cardiac surgery associated acute kidney injury

eGFR:

Estimated glomerular filtration rate

GFR:

Glomerular filtration rate

L-FABP:

L-type fatty acid-binding protein

MECC:

Mini-extracorporeal circulation

NAG:

N-acetyl-B-d-glucosaminidase

NGAL:

Neutrophil gelatinase-associated lipocalin

RAA:

Renin-angiotensin-aldosterone

RBC:

Red blood cells

RIFLE:

Risk, injury, failure, loss, and end-stage renal disease

RTT:

Renal replacement therapy

SCr:

Serum creatinine

SRI:

Simplified renal index

UO:

Urine output

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Authors and Affiliations

  1. Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, EA3920, University of Franche-Comté, 3 Boulevard Fleming, 25030, Besançon, France

    Andrea Perrotti & Sidney Chocron

  2. Department of Anesthesiology and Surgical Critical Care Medicine, University Hospital Jean Minjoz, 3 Boulevard Fleming, 25000, Besançon, France

    Benoit Barrucand

Authors
  1. Andrea Perrotti
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  2. Benoit Barrucand
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  3. Sidney Chocron
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Correspondence to Andrea Perrotti .

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Editors and Affiliations

  1. Department of Internal Medicine, Einstein Medical Center, Sidney Kimmel College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA

    Janani Rangaswami

  2. Department of Medicine, Section of Nephrology, University of Illinois at Chicago, Chicago, Illinois, USA

    Edgar V. Lerma

  3. Department of Nephrology Dialysis and Transplantation, International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy

    Claudio Ronco

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Perrotti, A., Barrucand, B., Chocron, S. (2017). Acute Kidney Injury After Cardiac Surgery. In: Rangaswami, J., Lerma, E., Ronco, C. (eds) Cardio-Nephrology. Springer, Cham. https://doi.org/10.1007/978-3-319-56042-7_34

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  • DOI: https://doi.org/10.1007/978-3-319-56042-7_34

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