Evaluación de fracaso renal agudo subclínico tras cirugía de aneurisma aórtico abdominal utilizando nuevos marcadores: L-FABP y H-FABP

Kokot, Michał; Biolik, Grzegorz; Ziaja, Damian; Fojt, Tadeusz; Kędzierski, Leszek; Antoniak, Katarzyna; Janowska, Mirosława; Pawlicki, Krzysztof; Ziaja, Krzysztof; Duława, Jan

doi:10.3265/Nefrologia.pre2014.Jul.11953

Article information

Antecedentes: Una de las complicaciones más graves de la cirugía reparatoria de aneurisma aórtico abdominal (AAA) es el fracaso renal agudo (FRA). Incluso un pequeño ascenso de creatinina sérica se asocia a un aumento de la mortalidad. El objetivo de este estudio ha sido valorar la dinámica del FRA después de cirugía electiva de AAA utilizando nuevos marcadores. Métodos: En el estudio se incluyeron 22 pacientes con AAA. Medimos la proteína hepática transportadora de ácidos grasos (u-L-FABP) y la proteína cardíaca transportadora de ácidos grasos (u-h-FABP) en orina, antes, durante y dentro de los tres días siguientes a la cirugía. Resultados: Se observó una brusca y significativa elevación de ambas FABP en orina, normalizada a creatinina en orina; el nivel de u-L-FABP alcanzó su pico dos horas después de quitar la abrazadera aórtica {137,79 (38,57-451,79) frente a 9,99 (6,82-12,42) ng/mg del valor basal p < 0,05; los valores son medianos (cuartil inferior-superior)}. El pico de la u-H-FABP se notó 72 horas después de quitar la abrazadera aórtica {16,462 (4,182-37,595) frente a 0,141 (0,014-0,927) ng/mg del valor basal}. El nivel de creatinina sérica no cambió de manera significativa durante el período de estudio. Conclusiones: El aumento significativo de ambas u-L-FABP y u-H-FABP después de cirugía de AAA indica la lesión tubular renal distal y proximal en la población estudiada. Nuestros resultados sugieren que después de una cirugía de AAA el túbulo distal puede ser más afectado que el proximal. Las u-FABP podrían servir como biomarcadores sensitivos de la lesión tubular renal y permitir detectar la fase más precoz de FRA.

Palabras clave:

Proteína hepática transportadora de ácidos grasos

Palabras clave:

Proteína cardíaca transportadora de ácidos grasos

Palabras clave:

Fracaso renal agudo

Palabras clave:

Cirugía de aneurisma aórtico abdominal

Background: One of the most severe complications of repair surgery for abdominal aortic aneurysms (AAA) is acute kidney injury (AKI). Even small rises in serum creatinine are associated with increased mortality. The aim of this study was to assess the dynamics of AKI after elective AAA surgery using novel markers. Methods: The study group consisted of 22 patients with AAA. We measured urinary liver- (u-L-FABP) and heart-type fatty acid-binding proteins (u-H-FABP) before, during and within 3 days after surgery. Results: We found an abrupt and significant elevation of both urine FABPs normalized to urinary creatinine; u-L-FABP reached its peak value 2 hours after aortic clamp release {137.79 (38.57-451.79) vs. 9.94 (6.82-12.42) ng/mg baseline value, p<0.05; values are medians (lower-upper quartile)}. The peak value of u-H-FABP was reported 72 hours after aortic clamp release {16.462 (4.182-37.595) vs. 0.141 (0.014-0.927) ng/mg baseline value, p<0.05}. The serum creatinine level did not changed significantly during the investigation period. Conclusions: The significant rise of both u-L-FABP and u-H-FABP after AAA surgery indicates renal proximal and distal tubule injury in this population. Our results suggest that, after AAA surgery, the distal tubules could be more affected than the proximal ones. u-FABPs could serve as sensitive biomarkers of kidney tubular injury and may allow to detect the very early phases of AKI.

Keywords:

Liver-type fatty acid-binding protein

Keywords:

Heart-type fatty acid-binding protein

Keywords:

Acute kidney injury

Keywords:

Abdominal aortic aneurysm surgery

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