Acute kidney injury after abdominal aortic aneurysm surgery: detailed assessment of early effects using novel markers.

INTRODUCTION:  One of the most severe complications of repair surgery for abdominal aortic aneurysms (AAA) is acute kidney injury (AKI). Even small rises in serum creatinine after surgery are associated with increased mortality. OBJECTIVES:  The aim of the study was to assess the dynamics of AKI after elective AAA surgery using novel markers. PATIENTS AND METHODS:  The study group consisted of 14 patients with AAA. We measured serum neutrophil gelatinase­associated lipocalin (NGAL) before, during (including intra­abdominal vein levels before and after removal of aortic clamp), and within 2 days after surgery.  Moreover, we assessed urinary NGAL, interleukin 18 (IL­18), and liver­type fatty acid­binding protein (L­FABP) before, during, and within 3 days after surgery. RESULTS:  We observed a marked but nonsignificant increase in serum NGAL directly after clamp removal (75.21 ±55.83 vs. 46.37 ±21.60 ng/ml baseline value, P >0.05) and significantly elevated plasma NGAL at 2 hours (91.54 ±76.54 vs. baseline, P <0.05), 12 hours (100.78 ±44.92 vs. baseline, P <0.05) and 24 hours (89.46 ±94.18 vs. baseline, P <0.05) after clamp release. There was also significant elevation of urinary IL­18 at 2 hours (51.60 [12.12-527.16] vs. 25.99 [9.34-187.80] pg/ml at baseline, P <0.05); L­FABP at 2 hours (47.10 [5.40-500.00] vs. 5.50 (2.20-27.20) ng/ml at baseline, P <0.05) and 12 hours (39.00 [5.20-500.00] vs. baseline, P <0.05); NGAL at 12 hours (20.75 [5.00-176.10] vs. 5.85 [1.40-16.00] ng/ml at baseline, P <0.05) and 24 hours (13.95 [3.90-163.30] vs. baseline, P <0.05) after clamp release. CONCLUSIONS:  Elective AAA surgery may induce AKI. Novel markers can facilitate early detection of AKI, thus allowing to start therapy at an appropriate time point.