[Renal tubular impairment after surgery]

Area of Science:

• Nephrology
• Surgical Medicine
• Biochemistry

Background:

• Acute renal failure (ARF) following surgery is a significant clinical concern with high mortality rates.
• Early detection of renal tubular damage is crucial for managing post-operative kidney function.
• Urinary beta 2 microglobulin (u-BMG) and N-acetyl-beta-D-glucosaminidase (u-NAG) are recognized sensitive biomarkers for renal tubular impairment.

Purpose of the Study:

• To investigate the incidence and indicators of renal tubular damage in patients undergoing surgery.
• To identify factors associated with elevated renal tubular damage markers post-operatively.
• To evaluate the potential protective effect of urinastatin on post-operative renal tubular function.

Main Methods:

• Measurement of urinary beta 2 microglobulin (u-BMG) and N-acetyl-beta-D-glucosaminidase (u-NAG) in 48 surgical patients.
• Assessment of conventional renal function tests.
• Correlation analysis of surgical factors (bleeding, operative time, complications, hypotension) with biomarker levels.

Main Results:

• Three out of 48 patients developed ARF.
• Many patients without overt ARF exhibited elevated u-BMG and u-NAG levels.
• Surgical bleeding, operative duration, circulatory shock, and preoperative hypotension correlated with increased u-BMG and u-NAG.
• Urinastatin administration inhibited u-NAG elevation but not u-BMG elevation postoperatively.

Conclusions:

• Elevated u-BMG and u-NAG are sensitive indicators of subclinical renal tubular damage after surgery.
• Surgical stress and complications are key contributors to post-operative renal tubular impairment.
• Urinastatin may offer some protection against post-operative renal tubular damage, specifically impacting u-NAG levels.