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Identifier 000429200
Title Πρώιμοι δείκτες μετεγχειρητικής νεφρικής δυσλειτουργίας
Alternative Title Early predictive markers of peri-operative acute kidney injury
Author Μαρούλη, Διαμαντίνας
Thesis advisor Ασκητοπούλου, Ελένη
Reviewer Γεωργόπουλος, Δημήτριος
Δαφνής, Ευγένιος
Abstract Acute kidney injury following major surgery represents a common, yet under-diagnosed entity which is known to be one of the most significant causes of perioperative morbidity and mortality, a fact which underscores the importance of this syndrome’s early diagnosis. While there is plenty of evidence regarding perioperative acute kidney injury in cardiac surgery patients, data for general surgery patients are limited. It is well known that serum creatinine concentration, which is still the most widespread method in assessing renal function and detecting renal damage, has rather limited value in the early detection of post-operative acute kidney injury and the assessment of acute changes in glomerular filtration rate, a fact which has resulted in the study of numerous alternative markers of acute kidney injury. The aim of the present study was a) to determine the incidence of acute kidney injury following major abdominal surgery and to recognize associated perioperative factors, b) to evaluate the role of serum cystatin C as well as other biochemical parameters of glomerular or tubular kidney damage as early markers of perioperative acute kidney ιinjury, before a diagnosis by traditional laboratory methods is established, in order to optimize perioperative patient management. Sixty-eight patients undergoing elective major abdominal surgery at the University Hospital of Heraklion were prospectively studied. Patients with chronic kidney disease stage IV or V, on hemodialysis or peritoneal dialysis as well as renal transplant patients were excluded. At pre-defined time points (preoperatively, recovery room and on postoperative days 1, 3, 5 and 7) the following parameters were measured: serum cystatine C, urea, creatinine, Na, K, prealbumin and retinol binding protein, as well as urine creatinine, urea, Na, K, Cl, a1- and b2-microglobulin, a2-macroglobulin, IgG, transferrin and albumin, while fractional excretions of sodium, potassium and urea, glomerular filtration rate, urine albumin to creatinine ratio and urine strong ion difference were calculated. Diagnosis of acute kidney injury was based on the Acute Kidney Injury Network criteria. This study showed that approximately one out of five elective major abdominal surgery patients developed perioperative acute kidney injury. Preoperative albuminuria, expressed as elevated urine albumin to creatinine ratio, was found to be independently associated with postoperative acute kidney injury development (OR = 5.47, 95% CI: 1.36-21.92, p = 0.019). The intraoperative factors found to be associated with perioperative acute kidney injury were blood loss (p = 0.002), RBC and FFP transfusion (p = 0.042 and 0.006 respectively), as well as the administered, by either crystalloid and/or colloid infusion, chloride load (p = 0.043). Compared to non-AKI patients, patients developing acute kidney injury had significantly lower urine sodium and chloride concentrations as well as a significantly higher fractional excretion of potassium. These differences were already evident in the recovery room, indicating an early decline in glomerular filtration rate, much earlier than AKI diagnosis by AKIN criteria can be established. Similarly, postoperative change in urine strong ion difference (ΔSIDU) was already in the recovery room significantly lower in AKI patients compared to non-AKI patients, indicating early impairment in chloride excretion due to tubular damage.
Language Greek
Subject Postoperative
Οξεία νεφρική βλάβη
Issue date 2020-03-24
Collection   Faculty/Department--School of Medicine--Department of Medicine--Doctoral theses
  Type of Work--Doctoral theses
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