Kidney injury after cardiopulmonary bypass in infants with congenital heart disease
TI Yun-Xing, PAN Zheng-Xia, WU Chun, WANG Gang, LI Hong-Bo, LI Yong-Gang, AN Yong, DAI Jiang-Tao
Key Laboratory of Developmental Diseases in Childhood (Chongqing Medical University), Ministry of Education, Chongqing 400014,China. Email: Panzhengxia@yahoo.com.cn
Abstract OBJECTIVE: To study kidney injury in infants with congenital heart disease (CHD) who underwent cardiac surgery with cardiopulmonary bypass (CPB). METHODS: Forty CHD infants undergoing cardiac surgery with CPB from October 2009 to July 2010 were enrolled. The concentrations of serum tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), cystatin C (CysC) and urinary N-acetyl-beta-D-glucosaminidase (NAG) were detected using ELISA before bypass, at the end of surgery, and 2 hrs, 6 hrs and 24 hrs after surgery. Serum concentrations of creatinine (Cr) and urea nitrogen (BUN) were measured with conventional biochemistry technique before and after surgery. RESULTS: The concentrations of serum Cr and BUN were normal before and after surgery. After CPB, the concentrations of serum TNF-α and IL-6 and urinary NAG increased significantly (P<0.05). Serum TNF-α was positively correlated with urinary NAG and serum CysC (r=0.195, 0.190,respectively; both P<0.05). Serum IL-6 was positively correlated with urinary NAG (r=0.278, P<0.01). The positive rate in kidney injury was detected by serum CysC and urinary NAG were significantly higher than by serum Cr or BUN (both P<0.01). CONCLUSIONS: CPB can cause acute kidney injury in infants, which may be correlated with the increase in the concentrations of serum TNF-α and IL-6. Serum CysC and urinary NAG may be used as sensitive markers for reflecting the changes of renal function.
TI Yun-Xing,PAN Zheng-Xia,WU Chun et al. Kidney injury after cardiopulmonary bypass in infants with congenital heart disease[J]. 中国当代儿科杂志, 2011, 13(5): 385-387.
TI Yun-Xing,PAN Zheng-Xia,WU Chun et al. Kidney injury after cardiopulmonary bypass in infants with congenital heart disease[J]. CJCP, 2011, 13(5): 385-387.
［1］Randers E, Krue S, Erlandsen EJ, Danielsen H, Hansen LG. Reference interval for serum cystatin C in children［J］.Clin Chem, 1999, 45(10): 1856-1858.
［2］Shin HS, Jung YS, Rim H. Reference values for serum cystatin C by nephelometric immunoassay in healthy young Korean men［J］.Korean J Nephrol, 2010, 29:17-22.
［3］Nishida M, Kawakatsu H, Komatsu H, Ishiwari K, Tamai M,Tsunamoto K, et al. Values for urinary beta 2-microglobulin and N-acetyl-beta-D-glucosaminidase in normal healthy infants［J］.Acta Paediatr Jpn, 1998, 40(5): 424-426.
［4］Pedersen KR, Povlsen JV, Christensen S, Pedersen J, Hjortholm K, Larsen SH, et al. Risk factors for acute renal failure requiring dialysis after surgery for congenital heart disease in children［J］.Acta Anaesthesiol Scand, 2007, 51(10): 1344-1349.
［5］Ricci Z, Stazi GV, Di Chiara L, Morelli S, Vitale V, Giorni C, et al. Fenoldopam in newborn patients undergoing cardiopulmonary bypass: controlled clinical trial［J］. Interact Cardiovasc Thorac Surg, 2008, 7(6): 1049-1053.
［6］Parikh CR, Mishra J, Thiessen-Philbrook H, Dursun B, Ma Q, Kelly C, et al. Urinary IL-18 is an early predictive biomarker of acute kidney injury after cardiac surgery［J］.Kidney Int, 2006, 70(1):199-203.
［10］Wan S, LeClerc JL, Vincent JL. Inflammatory response to cardiopulmonary bypass: mechanisms involved and possible therapeutic strategies［J］.Chest, 1997, 112(3): 676-692.
［11］Wan S, Yim AP. Multi-organ protection during open heart surgery［J］.Chin Med J (Engl), 2001, 114(1):3-8.
［13］Dittrich S, Aktuerk D, Seitz S, Mehwald P, Schulte-M-nting J, Schlensak C, et al. Effects of ultrafiltration and peritoneal dialysis on proinflammatory cytokines during cardiopulmonary bypass surgery in newborns and infants［J］.Eur J Cardiothorac Surg, 2004, 25(6): 935-940.
