Kardiyak Cerrahi Geçiren Erişkin Hastalarda, Preoperatif ve Postoperatif Erken Dönem Serum Beta-Trace Protein (Btp), Nötrofil Gelatinaz-Ilişkili Lipokalin (Ngal) Ve Sistatin C Düzeylerinin, Postoperatif Erken Dönemde Görülen Akut Böbrek Hasarı ile Ilişkisinin Değerlendirilmesi

Abstract

Acute renal failure is defined as; an abrupt decrease in kidney function, resulting in accumulation of urea and other nitrogenous waste products in body and disruption of the balance of extracellular volume and electrolytes. Cardiopulmonary bypass associated acute kidney injury is a common, but not fully understood condition. The development of acute kidney injury after cardiopulmonary bypass is associated with a significant increase in the rate of infections, prolonged hospital stay and increase in morbidity and mortality. However, rapid diagnosis and risk classification is important in management and prevention of disease progression. Identification of reliable biomarkers for early diagnosis of postoperative acute kidney injury may increase the chance of successful treatment. In this study; a 0.3 mg/dl increase in serum creatinine value, which is mentioned in AKIN and KDIGO criteria, is accepted for the definition of acute kidney injury. In this study; 57 patients who had cardiac surgery with cardiopulmonary bypass in the Department of Cardiovascular Surgery in Hacettepe University School of Medicine, were included. In order not to affect results; patients younger than 18 years, routine dialysis patients with chronic kidney disease and patients who have undergone beating coronary artery bypass surgery were excluded. In this study, emerging markers of kidney function such as serum beta-trace protein, NGAL and cystatin C are compared with serum creatinine, concerning early diagnosis of acute kidney injury. According to this study; acute renal failure was found to be related with prolonged stay in intensive are unit and increased total hospitalization (p=0.011, p<0.001 respectively). Elevated preoperative serum levels of beta-trace protein and elevated serum NGAL levels at postoperative 4th hour was found to be correlated with the development of acute kidney injury. Finally; serum Cystatin C was found to be the most reliable marker for detecting subclinical acute kidney injury after cardiac surgery, by being able to detect early acute renal injury even when serum creatinine could not, and by being significant in the following hours.