Express-diagnosing of acute kidney injury among patients with the localized kidney cancer after partial nephrectomy under warm ischemia: A role of biomarkers.

Abstract

e16108 Background: The specialists consider partial nephrectomy (PN) under warm ischemia (WI) as a standard treatment option for localized renal cell carcinoma (RCC) patients. However, clinical use of the method is restricted by acute kidney injury (AKI) development among patients with high R.E.N.A.L. score, which usually demands long warm ischemia time (WIT). The purpose of the study consists in assessing of the diagnostic ability of cystatin С, IL-18, KIM-1, L-FABP and NGAL in express-diagnosing of AKI among patients with the localized kidney cancer after PN under WI. Methods: The sample of the examined patients consists data of the retrospective research of 100 cases with a localized RCC who underwent PN for elective indications using WI. The WIT was about 15-21 minutes. 24 hours prior to and 16 hours after the surgery, using the ELISA technique and standard test-systems the serum concentration of the following “early markers of AKI” was tested: cystatin С (BioVendor, Czech Republic), КIМ-1 (BCMDiagnostics, USA), NGAL (BCMDiagnostics, USA), L-FABP (Hycult Biotechnology, Netherlands), IL-18 (BenderMedsystems, USA). The WIT and diuresis rate were also registered. AKI was diagnosed based on the serum creatinine level measuring in accordance with the KDIGO guidelines. The clinical and laboratory data were processed using MS Excel software; the Wilcoxon test was used. Simultaneously the expert analysis of the data was carried out. Results: The AKI was registered in 24 patients having a preoperative serum cystatin С level higher than 1000 ng/ml. Another risk factor was WIT lasting 15-21 min. All patients with AKI had an increase of serum concentrations of all 3 following markers: cystatin С, NGAL and L-FABP by more than 10 per cent each (in relation to a preoperative level by each patient). In 5 patients (among the 24 ones) an elevation of creatinine serum concentration was registered just after 40 hours after the surgery – much later than the markers’ reaction appeared. Based on the expert analysis of the clinical and laboratory data the personified scale of early AKI diagnosing and its graphical representation in a form of three-dimensional model was developed. Conclusions: The new method allows diagnosing the AKI development after 16 hours in patients who underwent PN under WI on occasion of RCC. The method has good perspectives of clinical use as it allows identifying the AKI development before elevation of a serum creatinine concentration.