Hasan SUNAR, Ali FEDAKAR, Bahadır DAĞLAR, Kemalettin ERDEM, Onursal BUĞRA, Ayşe BAYSAL

İnsüline bağlı diyabeti olan hastalarda gerçekleştirilen koroner arter baypas greft cerrahisinde serum nötrofil jelatinaz ilişkili lipokalin belirteci böbrek fonksiyonlarındaki bozulmayı erken dönemde belirler mi?

Amaç: Bu çalışmada koroner arter baypas greftleme (KABG) yapılan diabetes mellitus hastalarında serum nötrofil jelatinaz ilişkili lipokalin (NGAL) belirtecinin böbrek hasarının erken belirlenmesindeki etkisi araştırıldı.Çalışmaplanı:Ocak 2010 - Aralık 2011 tarihleri arasında kliniğimizde kardiyopulmoner baypas (KPB) ile izole elektif KABG yapılan 113 hasta iki gruba ayrıldı. Grup 1'in (33 erkek, 20 kadın; ort. yaş 63.6±7.2 yıl; dağılım 50-73 yıl) rutin böbrek fonksiyonları ve serum NGAL düzeyleri; grup 2'nin ise (40 erkek, 20 kadın; ort. yaş 64.6±8.3 yıl; dağılım 49-76 yıl) yalnızca rutin böbrek fonksiyonları ölçüldü. Parametreler KPB sonrası 2, 24. ve 72. saatlerde toplandı. Serum kreatinin değerinin 1.2 mg/dL üzerinde olması böbrek hasarı olarak tanımlandı. Bu tanıma göre çalışma grupları alt gruplara ayrıldı. Erken ameliyat sonrası dönemde, serum NGAL değerleri ile akut böbrek yetmezliği gelişimi arasındaki muhtemel ilişki gruplar arası ve alt gruplarda incelendi.Bul gu lar: Kardiyopulmoner baypas sonrası ikinci saat serum NGAL ölçümüne göre böbrek hasarı olan hastaların tümünde, KPB sonrası 72. saat serum kreatinin ölçümlerinde de böbrek hasarı saptandı. Kardiyopulmoner baypas sonrası 72. saat serum kreatinin ölçümüne göre böbrek hasarı olmayan hastaların tümü, KPB sonrası ikinci saat serum NGAL ölçümlerinde de böbrek hasarı saptanmayan hastalardı. Kardiyopulmoner baypas sonrası 72. saatteki böbrek hasarını öngörmede, KPB sonrası ikinci saat serum NGAL düzeylerinin belirleyici olduğu görüldü.So nuç: Kardiyopulmoner baypas sonrası ikinci saatte serum NGAL değerlerinde yükselme böbrek hasarının kuvvetli bir göstergesidir ve alınması gereken tedbirler açısından erken bir uyarıcı olabilir. Serum kreatinin değerlerindeki yükselme genellikle geç dönemde olmaktadır ve bu nedenle tespit edildiğinde böbrek hasarı önlenemeyebilir

Does serum neutrophil gelatinase-associated lipocalin biomarker detect the early deterioration in renal functions in patients with insulin-dependent diabetes mellitus undergoing coronary artery bypass graft surgery?

Background: This study aims to investigate the effects of serum neutrophil gelatinase-associated lipocalin (NGAL) on early detection of renal injury in patients with diabetes mellitus undergoing coronary artery bypass grafting (CABG). Methods: Between January 2010 and December 2011, 113 patients who underwent an isolated elective CABG with cardiopulmonary bypass (CPB) in our clinic were divided into two groups. Routine renal functions and serum NGAL were measured in group 1 (33 males, 20 females; mean age 63.6±7.2 years; range 50 to 73 years), while only routine renal functions were measured in group 2 (40 males, 20 females; mean age 64.6±8.3 years; range 49 to 76 years). Parameters were collected at 2, 24 and 72 hours after CPB. Renal injury was defined as serum creatinine level exceeding 1.2 mg/dL. Based on this definition, study groups were divided into subgroups. A possible correlation between serum NGAL values and development of acute renal failure in the early postoperative period was investigated in between the groups and subgroups. Results: All patients with renal injury according to the measurements of serum NGAL values at two hours following CPB had renal injury based on serum creatinine measurements at 72 hours of CPB. All patients without renal injury based on serum creatinine measurements at 72 hours of CPB did not have renal injury based on NGAL measurements at two hours of CPB. Serum NGAL values at two hours after CPB appeared to be determinants in predicting the development of acute renal injury at 72 hours. Conclusion: Elevated levels of serum NGAL at two hours after CPB are strong indicators of renal injury and may be an early warning on the measures to be taken. Serum creatinine levels are usually increased in the late stage and, therefore, renal injury can not be prevented when detected

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