Intervention of NGAL and HO-1 in valve replacement surgery-induced acute kidney injury

Abstract

To determine the pathological mechanism and prevent heart-renal syndrome after heart valve replacement surgery. A total of 46 patients were admitted for selective valve replacement, and divide into 3 groups randomly: a control group (Con, n=16), a remote ischemic perconditioning (RIPerC) group (n=15) and a remote ischemic postconditioning (RIPostC) group (n=15). The serum creatinine (SCr), blood urea nitrogen (BUN), serum heme oxygennase-1 (HO-1), serum iron and urinary neutrophil gelatinase associated lipocalin (NGAL) level in the 3 groups were compared preoperatively and 6, 12, 24, 48 h after aortic cross-release. Compared with the preoperative level, the SCr, BUN, urinary NGAL, serum iron (6 and 12 h) and serum HO-1 values were significantly increased after the heart valve replacement surgery in the control patients, RIPreC and RIPostC groups (P<0.05). Compared with the control group, the serum HO-1 was significantly increased at 6, 12, 24, 48 h after the heart valve replacement surgery in both the RIPerC and RIPostC groups (P<0.05); the SCr, BUN, urinary NGAL and serum iron values were decreased at 6, 12, 24, 48 h after the heart valve replacement surgery in both the RIPerC and RIPostC groups (P>0.05). Abnormal change in urinary NGAL, serum iron and HO-1 can be used as early warning indicators of acute kidney injury when cardio-renal syndrome occurrs among patients under heart valve replacement surgery. Remote ischemic conditioning plays a preventive role in the occurrence of cardio-renal syndrome and renal protection.