Can urinary neutrophil gelatinase-associated lipocalin have a role in the early diagnosis of acute kidney injury after coronary artery bypass graft?

Aiyoub Pezeshgi,Kurosh Kamali,Abdolreza Esmaeilzadeh,Mahrang Hedaiaty,Alireza Behmanesh,Hossein Chiti

doi:10.34172/jrip.2020.12

Abstract

Introduction: The role of urinary neutrophil gelatinase-associated lipocalin (NGAL) as a prognostic biomarker in acute kidney injury (AKI) associated with coronary bypass graft has been suggested in some studies. However, the results have been inconclusive in different studies. Objectives: In the present research, we investigated the diagnostic and prognostic roles of NGAL in Iranian patients who developed AKI after coronary bypass surgery. Patients and Methods: This study was cross-sectional conducted on adult patients undergoing coronary artery bypass graft (CABG) surgery. Postoperative AKI was defined based on the RIFLE (risk, injury, failure, loss and end-stage kidney disease) criteria. Patients were divided into AKI and non-AKI groups. The urinary NGAL and serum creatinine levels were measured at different times after surgery. Results: Out of 29 patients, men constituted 75.9% of cases. Mean age of the patients was 61.4±7.7 years old and the mean duration of surgery was 4.9±0.6 hours. Based on serum creatinine, AKI was diagnosed in 37.9%, 17.25%, and 13.8% of patients at first, second, and third day post-surgery, respectively. The urine NGAL increased by 48.35% and 34.5% at 2 and 6 hours after surgery, respectively. However, there was no significant association between the urinary NGAL level and the incidence of post-surgery AKI. Conclusion: This study showed that urinary NGAL was inapplicable to independently diagnose or predict the outcome of transient AKI associated with CABG.

Highlights

The role of urinary neutrophil gelatinase-associated lipocalin (NGAL) as a prognostic biomarker in acute kidney injury (AKI) associated with coronary bypass graft has been suggested in some studies
Our findings showed that urinary NGAL level was not a reliable diagnostic or prognostic marker to diagnose or predict transient AKI associated with coronary artery bypass graft (CABG) within the first six hours after the procedure in adults
Contrary to the previous studies, the present research showed no significant associations between urinary NGAL levels at neither two hours nor six hours of post-surgery and the incidence of AKI

Summary

Introduction

The role of urinary neutrophil gelatinase-associated lipocalin (NGAL) as a prognostic biomarker in acute kidney injury (AKI) associated with coronary bypass graft has been suggested in some studies. Objectives: In the present research, we investigated the diagnostic and prognostic roles of NGAL in Iranian patients who developed AKI after coronary bypass surgery. AKI was diagnosed in 37.9%, 17.25%, and 13.8% of patients at first, second, and third day post-surgery, respectively. There was no significant association between the urinary NGAL level and the incidence of post-surgery AKI. Conclusion: This study showed that urinary NGAL was inapplicable to independently diagnose or predict the outcome of transient AKI associated with CABG. The coronary artery bypass grafting (CABG) is annually conducted in around 1 000 000 patients [1] which up to 30% of them develop. The CABG-associated renal injury is generally defined as an increase in serum creatinine either 0.3 mg/dL (≥26.4 μmol/L) or 50% of the baseline value (i.e. 1.5 folds from the baseline) within 48 hours postoperation [3]

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