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Beta-2-microglobulin as an index of renal function after cardiopulmonary bypass surgery in children
F Fernandez1, M D de Miguel, V Barrio
1Department of Pediatrics, Reina Sofia Hospital, Córdoba, Spain.
Insights
Serum and urinary beta-2-microglobulin (beta 2-m) show promise as markers for detecting renal damage after cardiopulmonary bypass (CPB) surgery in children. Increased urinary beta 2-m levels indicate kidney injury following CPB.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Surgery
- Biomarker Discovery
Background:
- Cardiopulmonary bypass (CPB) surgery in children can lead to acute renal failure (ARF).
- Early detection of renal damage is crucial for managing pediatric patients undergoing CPB.
- Traditional renal function tests may not always provide timely or sensitive indicators of kidney injury post-CPB.
Purpose of the Study:
- To evaluate the clinical utility of serum and urinary beta-2-microglobulin (beta 2-m) as markers of renal damage in children after CPB.
- To compare beta 2-m levels with traditional renal function tests (creatinine, creatinine clearance, fractional sodium excretion) in this population.
Main Methods:
- A cohort of 37 children undergoing CPB for congenital malformations was studied.
- Renal function and beta 2-m levels (serum and urine) were measured at baseline, and on postoperative days 1 and 3.
- Acute renal failure (ARF) and renal hypoperfusion were defined using established clinical criteria.
Main Results:
- The incidence of ARF was 18.9%, with a mortality rate of 21.7% overall and 71.4% among those with ARF.
- While creatinine and fractional sodium excretion normalized by day 3, creatinine clearance remained significantly decreased.
- Serum beta 2-m mirrored creatinine trends, but urinary beta 2-m and its fractional excretion were significantly elevated throughout the study period.
Conclusions:
- Urinary beta 2-m appears to be a sensitive and sustained marker of renal damage following pediatric CPB surgery.
- Beta 2-m determination, particularly the urinary form, may offer a valuable adjunct to traditional tests for monitoring kidney function post-CPB.
- The elevated urinary beta 2-m suggests ongoing renal tubular injury or dysfunction in children after CPB.
Abstract:
In order to evaluate the clinical usefulness of serum and urinary beta-2-microglobulin (beta 2-m) determination as a marker of renal damage following cardiopulmonary bypass surgery (CPB), 37 children, with an age range of 6 months to 13 years undergoing CPB under hypothermia and cardioplegia for congenital malformations, were studied. Renal function was monitored at baseline and on the first and third day after CPB by traditional tests such as creatinine (Cr), endogenous creatinine clearance (Ccr), and fractional sodium excretion (FeNa), as well as by serum and urinary beta 2-m measured by radioimmunosorbent assay. Data were analyzed for the group as a whole and after stratification for the presence of acute renal failure (ARF) defined by an increase in Cr greater than 0.5 mg/dl and/or FeNa greater than 2% and of renal hypoperfusion which was considered in case of hypotension resistant to volume repletion and/or dopamine infusion and of oliguria (less than 1.0 ml/kg/h). The incidence of ARF was 18.9%, mortality 21.7% and among those who developed ARF, 71.4%. Although Cr and FeNa increased significantly on the first postoperative day, values returned to baseline thereafter, probably because of the high mortality rate observed among those who developed ARF and were therefore lost to follow-up. In contrast, Ccr was significantly decreased during the whole study. Even though serum beta 2-m displayed a similar profile to Cr and FeNa returning to baseline by the third day, urinary and fractional excretion of beta 2-m were significantly increased at any time of the study.(ABSTRACT TRUNCATED AT 250 WORDS)