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Renal effects of cardiopulmonary bypass in the elderly
Marius G Dehne1, Armin Sablotzki, Jörg Mühling
1Department of Anesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Germany. marius.g.dehne@chiru.med.uni-giessen.de
Insights
Cardiopulmonary bypass may harm kidney function in older adults. New markers like alpha1-microglobulin (alpha1-MG) and immunoglobulin G (IgG) help detect early kidney damage after cardiac surgery.
Area of Science:
- Nephrology
- Cardiology
- Geriatric Medicine
Background:
- Cardiopulmonary bypass (CPB) is associated with renal injury.
- The impact of CPB on renal function in elderly patients is not fully understood.
- Assessing renal function in older adults undergoing coronary artery bypass grafting (CABG) is crucial.
Purpose of the Study:
- To evaluate renal function and identify early markers of kidney damage in elderly patients undergoing CABG.
- To compare renal function across different age groups of older adults undergoing CPB.
Main Methods:
- Thirty male patients undergoing CABG were divided into three age groups (≤60, 61-70, and ≥71 years).
- Serum creatinine, urea, creatinine clearance, and urinary excretion of alpha1-microglobulin (alpha1-MG), N-acetyl-beta-D-glucosaminidase (NAG), Tamm-Horsfall protein (TH), and immunoglobulin G (IgG) were measured daily, pre- and postoperatively.
- Creatinine clearance and urinary marker excretion were analyzed to assess renal function.
Main Results:
- Creatinine clearance was lower in older patients, though not significantly different between groups.
- Postoperative CPB led to increased urinary excretion of alpha1-MG and IgG.
- Elevated alpha1-MG and NAG levels indicated tubular damage in all elderly patients.
Conclusions:
- Measurements of alpha1-MG, NAG, and IgG are valuable additions to standard clinical tests for detecting early and differentiated renal function changes in elderly patients post-CPB.
- These markers can aid in recognizing subclinical renal dysfunction following cardiac surgery in older adults.
Abstract:
Cardiopulmonary bypass is widely believed to be injurious to renal function. The unknown consequences of renal dysfunction with modern techniques of bypass in the elderly caused us to examine creatinine clearance and the excretion of sensitive marker proteins in older adult patients undergoing CABG. Thirty male patients were divided into three groups: group I with an age up to 60 years, group II with an age between 61 and 70 years, inclusive and group III 71 years and over. Serum creatinine and urea, creatinine clearance, and alpha1-microglobulin (alpha1-MG), N-acetyl-beta-D-glucosaminidase (NAG), Tamm-Horsfall protein (TH) and immunoglobulin G (IgG) were all measured daily, pre- and postoperatively. Creatinine clearance remained lower in the older patients without significant differences. Raised excretion rates of alpha1-MG, and IgG were seen after CPB. The increase in alpha1-MG and NAG during the postoperative period revealed tubular damage in all elderly patients. Measurements of alpha1-MG, NAG and IgG represent useful supplements to standard clinical tests for recognizing early and differentiated changes in renal function.