Abstract
BackgroundAlthough intraperitoneal surgery is a major operation associated with postoperative acute kidney injury (AKI), the incidence, risk factors, and long-term renal outcome are not well known. We aimed to determine the risk factors and 6 months renal outcome in patients with clinical or subclinical AKI after hepatobiliary surgery. We also assessed the validity of urine neutrophil gelatinase-associated lipocalin (NGAL) in the early detection of AKI or prediction of renal outcome.MethodsThis prospective observational study enrolled patients with normal renal function who underwent hepatobiliary surgeries. Urine and serum samples were collected for NGAL measurement.ResultsAmong 131 patients, 10 (7.6%) developed postoperative AKI. Urine NGAL at 12 h postsurgery was the most predictive parameter for the diagnosis of AKI (cutoff, 92.85 ng/mL). With the cutoff value, subclinical AKI was diagnosed in 42 (32.1%) patients. Patients with clinical AKI and those with subclinical AKI were assigned to the AKI group. The AKI group had significantly higher model for end-stage liver disease and sodium (MELD-Na) score, lower albumin level, and longer hospital stay after surgery than the non-AKI group. Older age and higher MELD-Na score were independent risk factors for the development of postoperative AKI. At 6 months postsurgery, the estimated glomerular filtration rate (eGFR) in the AKI group was significantly lower than that in the non-AKI group, although the baseline eGFR was not different. In multiple linear regression analysis, the maximum urine NGAL level during 24 h postsurgery, intraoperative fluid balance, and having liver transplantation were significantly associated with a poor 6 months renal outcome.ConclusionUrine NGAL was useful in the early diagnosis of postoperative AKI as well as in predicting the 6 months renal outcome after hepatobiliary surgery. A considerable proportion of patients developed subclinical AKI, and these patients showed worse renal outcome compared with the non-AKI group.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2369-15-169) contains supplementary material, which is available to authorized users.
Highlights
Intraperitoneal surgery is a major operation associated with postoperative acute kidney injury (AKI), the incidence, risk factors, and long-term renal outcome are not well known
Intraperitoneal surgery has been known as a common risk factor for postoperative acute kidney injury (AKI) along with cardiac surgery with cardiopulmonary bypass or vascular procedures with aortic cross-clamping
Most (8 of 10) clinical AKI occurred in patients who had liver transplantation
Summary
Intraperitoneal surgery is a major operation associated with postoperative acute kidney injury (AKI), the incidence, risk factors, and long-term renal outcome are not well known. We assessed the validity of urine neutrophil gelatinase-associated lipocalin (NGAL) in the early detection of AKI or prediction of renal outcome. Intraperitoneal surgery has been known as a common risk factor for postoperative acute kidney injury (AKI) along with cardiac surgery with cardiopulmonary bypass or vascular procedures with aortic cross-clamping. The validity of new biomarkers in the early detection of AKI or in predicting outcome after intraperitoneal surgery is not known due to the paucity of data. Since newly emerging biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 have been extensively validated as more sensitive early diagnostic markers for AKI than serum creatinine, the concept of subclinical AKI has recently emerged. A few studies demonstrated the poor outcome of patients who were classified as having subclinical AKI, the clinical significance of these patients further needs to be determined
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
