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Renal injury in cardiac surgery

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https://www.readbyqxmd.com/read/29212948/elevated-urinary-creld2-is-associated-with-endoplasmic-reticulum-stress-mediated-kidney-disease
#1
Yeawon Kim, Sun-Ji Park, Scott R Manson, Carlos Af Molina, Kendrah Kidd, Heather Thiessen-Philbrook, Rebecca J Perry, Helen Liapis, Stanislav Kmoch, Chirag R Parikh, Anthony J Bleyer, Ying Maggie Chen
ER stress has emerged as a signaling platform underlying the pathogenesis of various kidney diseases. Thus, there is an urgent need to develop ER stress biomarkers in the incipient stages of ER stress-mediated kidney disease, when a kidney biopsy is not yet clinically indicated, for early therapeutic intervention. Cysteine-rich with EGF-like domains 2 (CRELD2) is a newly identified protein that is induced and secreted under ER stress. For the first time to our knowledge, we demonstrate that CRELD2 can serve as a sensitive urinary biomarker for detecting ER stress in podocytes or renal tubular cells in murine models of podocyte ER stress-induced nephrotic syndrome and tunicamycin- or ischemia-reperfusion-induced acute kidney injury (AKI), respectively...
December 7, 2017: JCI Insight
https://www.readbyqxmd.com/read/29210291/use-of-cerebral-oxygen-saturation-and-hemoglobin-concentration-to-predict-acute-kidney-injury-after-cardiac-surgery
#2
Canan Balci, Engin Haftaci, Atike Tekeli Kunt
Objective Acute kidney injury (AKI) is a common complication after cardiac surgery and is associated with significant morbidity and mortality. Near infrared spectroscopy (NIRS) is a noninvasive technique for real-time measurement of cerebral tissue oxygenation. The purpose of the present study was to evaluate the correlation of AKI with hemoglobin and regional cerebral oxygen saturation (rScO2) measured intraoperatively and postoperatively in patients undergoing cardiac surgery. Methods We retrospectively analyzed the prospectively collected data of 45 adult patients with normal renal function who underwent isolated coronary artery bypass grafting (CABG) from January 2014 to May 2014...
January 1, 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/29199540/is-the-use-of-hydroxyethyl-starch-as-priming-solution-during-cardiac-surgery-advisable-a-randomized-single-center-trial
#3
Øyvind S Svendsen, Marit Farstad, Arve Mongstad, Rune Haaverstad, Paul Husby, Venny L Kvalheim
INTRODUCTION: The use of cardiopulmonary bypass (CPB) leads to increased fluid filtration and edema. The use of artificial colloids to counteract fluid extravasation during cardiac surgery is controversial. Beneficial effects on global fluid loading, leading to better cardiac performance and hemodynamics, have been claimed. However, renal function and coagulation may be adversely affected, with unfavorable impact on outcome following cardiac surgery. METHODS: Forty patients were randomly allocated to study groups receiving either acetated Ringer's solution (CT group) or hydroxyethyl starch (HES group, Tetraspan®) as CPB priming solution...
December 1, 2017: Perfusion
https://www.readbyqxmd.com/read/29190218/validation-of-a-real-time-minute-to-minute-urine-output-monitor-and-the-feasibility-of-its-clinical-use-for-patients-undergoing-cardiac-surgery
#4
Aaron J Chang, Yohei Nomura, Viachaslau M Barodka, Daijiro Hori, Jonathan T Magruder, Nevin M Katz, Dan E Berkowitz, Charles W Hogue
Acute kidney injury after cardiac surgery is associated with increased morbidity and mortality. Methods for measuring urine output in real time may better ensure renal perfusion perioperatively in contrast to the current standard of care where urine output is visually estimated after empiric epochs of time. In this study, we describe an accurate method for monitoring urine output continuously during cardiopulmonary bypass. This may provide a means for setting patient-specific targets for blood pressure and cardiopulmonary bypass flow as a potential strategy to reduce the risk for acute kidney injury...
December 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29184415/reversible-preoperative-renal-dysfunction-does-not-add-to-the-risk-of-postoperative-acute-kidney-injury-after-cardiac-valve-surgery
#5
Jia-Rui Xu, Ya-Min Zhuang, Lan Liu, Bo Shen, Yi-Mei Wang, Zhe Luo, Jie Teng, Chun-Sheng Wang, Xiao-Qiang Ding
Objective: To evaluate the impact of the renal dysfunction (RD) type and change of postoperative cardiac function on the risk of developing acute kidney injury (AKI) in patients who underwent cardiac valve surgery. Method: Reversible renal dysfunction (RRD) was defined as preoperative RD in patients who had not been initially diagnosed with chronic kidney disease (CKD). Cardiac function improvement (CFI) was defined as postoperative left ventricular ejection function - preoperative left ventricular ejection function (ΔEF) >0%, and cardiac function not improved (CFNI) as ΔEF ≤0%...
2017: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/29173963/acute-kidney-injury-it-s-not-just-the-big-burns
#6
L A Kimmel, S Wilson, R G Walker, Y Singer, H Cleland
BACKGROUND: Acute Kidney Injury (AKI) complicates the management of at least 25% of patients with severe burns and is associated with long term complications. Most research focuses on the patients with more severe burns, and whether the same factors are associated with the development of AKI in patients with burns between 10 and 19% total body surface area (TBSA) is unknown. The aims of this study were to examine the incidence of, and factors associated with, the development of AKI in patients with%TBSA≥10, as well as the relationship with hospital metrics such as length of stay (LOS)...
November 16, 2017: Injury
https://www.readbyqxmd.com/read/29166543/transcatheter-or-surgical-aortic-valve-replacement-in-patients-with-advanced-kidney-disease-a-propensity-score-matched-analysis
#7
Rajkumar Doshi, Jay Shah, Vaibhav Patel, Varun Jauhar, Perwaiz Meraj
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an alternative for surgically inoperable patients with severe aortic stenosis. Advanced kidney disease may significantly affect outcomes in patients treated with TAVR and surgical aortic valve replacement (SAVR). HYPOTHESIS: TAVR is associated with better in-hospital outcomes compared with SAVR in patients with advanced kidney disease. METHODS: We identified our sample from the National Inpatient Sample between 2012 and 2014, using International Classification of Diseases, Ninth Revision, Clinical Modification codes...
November 22, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/29152949/effects-of-valproic-acid-on-sympathetic-activity-and-left-ventricularmyocardial-remodelling-in-rats-during-pressure-overload
#8
Yang Liu, Siyu Li, Zhigang Zhang, Zhanjun Lv, Huijie Jiang, Xiao Tan, Fengquan Liu
Background/aim: Pressure overload induces cardiac remodelling and results in heart failure. Enhanced sympathetic outflow participates in the development of cardiac remodelling for the duration of pressure overload as an independent factor. Valproic acid has recently been shown to reduce neuronal injury and have antiinflammatory and antiapoptotic effects as a histone deacetylase inhibitor. We speculate that the drug plays a specific role in alleviating cardiac remodelling by inhibiting sympathetic activity. Materials and methods: Surgery of partial abdominal aortic constriction was performed on male Sprague-Dawley rats...
November 13, 2017: Turkish Journal of Medical Sciences
https://www.readbyqxmd.com/read/29150842/the-effect-of-6-hydroxyethyl-starch-130-0-4-on-acute-kidney-injury-in-paediatric-cardiac-surgery-a-prospective-randomised-trial
#9
H-W Oh, J-H Lee, H-C Kim, E-H Kim, I-K Song, H-S Kim, J-T Kim
We have evaluated the effect of a colloid solution on acute kidney injury in paediatric cardiac surgery. A total of 195 patients were ramdomly divided into an hydroxyethyl starch group and a control group. In the starch group, 6% hydroxyethyl starch 130/0.4 (Volulyte® ) was used as the primary fluid for volume resuscitation but was limited to 30 ml.kg-1 . In the control group, only crystalloid fluid was used during the peri-operative period. The incidence of acute kidney injury, peri-operative transfusion, clinical outcomes and laboratory data were compared...
November 17, 2017: Anaesthesia
https://www.readbyqxmd.com/read/29149189/perioperative-body-weight-change-is-associated-with-in-hospital-mortality-in-cardiac-surgical-patients-with-postoperative-acute-kidney-injury
#10
Chih-Chung Shiao, Ya-Ting Huang, Tai-Shuan Lai, Tao-Min Huang, Jian-Jhong Wang, Chun-Te Huang, Pei-Chen Wu, Che-Hsiung Wu, I-Jung Tsai, Li-Jung Tseng, Chih-Hsien Wang, Tzong-Shinn Chu, Kwan-Dun Wu, Vin-Cent Wu
BACKGROUND: Postoperative acute kidney injury (AKI) is common following cardiac surgery (CS). Body weight (BW) may be an amenable variable by representing the summation of the nutritional and the fluid status. However, the predictive role of perioperative BW changes in CS patients with severe postoperative AKI is never explored. This study aimed to evaluate this association. METHODS: This study was conducted using a prospectively collected multicenter cohort, NSARF (National Taiwan University Hospital Study Group on Acute Renal Failure) database...
2017: PloS One
https://www.readbyqxmd.com/read/29137024/effect-of-different-surgical-type-of-coronary-artery-bypass-grafting-on-kidney-injury-a-propensity-score-analysis
#11
Ming-Jen Chan, Cheng-Chia Lee, Shao-Wei Chen, Feng-Chun Tsai, Pyng-Jing Lin, Pei-Chun Fan, Hsiang-Hao Hsu, Ming-Yang Chang, Yung-Chang Chen, Chih-Hsiang Chang
Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) is associated with a less favorable outcome. Off-pump surgery results in lower kidney dysfunction than conventional on-pump arrest surgery. On-pump arrest surgery results in a lower revascularization rate compared with off-pump surgery. On-pump beating heart (OPBH) CABG combines the advantages of beating heart surgery and cardiopulmonary bypass. This study compared the renal outcomes of 3 cardiac surgical methods. From January 2010 to December 2012, 373 patients who underwent on-pump CABG were enrolled...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29135158/-the-role-of-pharmacological-preconditioning-in-renal-ischemic-and-reperfusion-injury
#12
D A Kostina, T G Pokrovskaya, Yu V Olefir, A N Yavorskii, V V Elagin
Renal ischemic and reperfusion injury resulting in acute renal failure is a multidisciplinary problem at the junction of pathophysiology, transplantology, urology, nephrology, cardiac surgery and pharmacology. One of renal protection strategies is using the phenomenon of preconditioning. Preconditioning is one of the ways to adopt a tissue to repeated short-term effects of damaging factors to induce an enhanced tolerance to the long period of hypoxia and/or ischemia. There are multiple cellular and molecular mechanisms of the renal protective effects of preconditioning stimuli, but the key effectors and signaling molecules are ATP-dependent potassium channels, nitric oxide synthase, nitric oxide, and mitochondrial pore...
October 2017: Urologii︠a︡
https://www.readbyqxmd.com/read/29127739/renal-haemodynamics-and-oxygenation-during-and-after-cardiac-surgery-and-cardiopulmonary-bypass
#13
REVIEW
Roger G Evans, Yugeesh R Lankadeva, Andrew D Cochrane, Bruno Marino, Naoya Iguchi, Michael Z L Zhu, Sally G Hood, Julian A Smith, Rinaldo Bellomo, Bruce S Gardiner, Chang-Joon Lee, David W Smith, Clive N May
Acute kidney injury (AKI) is a common complication following cardiac surgery performed on cardiopulmonary bypass (CPB) and has important implications for prognosis. The aetiology of cardiac surgery-associated AKI is complex, but renal hypoxia, particularly in the medulla, is thought to play at least some role. There is strong evidence from studies in experimental animals, clinical observations and computational models, that medullary ischaemia and hypoxia occurs during CPB. There are no validated methods to monitor or improve renal oxygenation during CPB, and thus possibly decrease the risk of AKI...
November 11, 2017: Acta Physiologica
https://www.readbyqxmd.com/read/29126653/perioperative-levosimendan-in-cardiac-surgery-a-systematic-review-with-meta-analysis-and-trial-sequential-analysis
#14
Alessandro Putzu, Sara Clivio, Alessandro Belletti, Tiziano Cassina
BACKGROUND: Several studies suggested beneficial effects of perioperative levosimendan on postoperative outcome after cardiac surgery. However, three large randomized controlled trials (RCTs) have been recently published and presented neutral results. We performed a systematic review with meta-analysis and trial sequential analysis (TSA) to assess benefits and harms of perioperative levosimendan therapy in cardiac surgery. METHODS: Electronic databases were searched up to September 2017 for RCTs on preoperative levosimendan versus any type of control...
October 21, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/29073282/cardiovascular-phenotype-in-smad3-deficient-mice-with-renovascular-hypertension
#15
Sonu Kashyap, Gina Warner, Zeng Hu, Feng Gao, Mazen Osman, Yousif Al Saiegh, Karen R Lien, Karl Nath, Joseph P Grande
Renovascular hypertension (RVH) has deleterious effects on both the kidney and the heart. TGF-β signaling through Smad3 directs tissue fibrosis in chronic injury models. In the 2-kidney 1-clip (2K1C) model of RVH, employing mice on the 129 genetic background, Smad3 deficiency (KO) protects the stenotic kidney (STK) from development of interstitial fibrosis. However, these mice have an increased incidence of sudden cardiac death following 2K1C surgery. The purpose of this study was to characterize the cardiovascular phenotype of these mice...
2017: PloS One
https://www.readbyqxmd.com/read/29071091/the-use-of-the-renalguard-system-in-cardiac-surgery-with-cardiopulmonary-bypass-a-first-in-man-prospective-observational-feasibility-pilot-study
#16
Heyman Luckraz, Ramesh Giri, Benmjamin Wrigley, Anne-Marie Hennessy, Johann Nicholas, Alan Nevill
OBJECTIVES: As proof of concept, this prospective, observational study assessed the feasibility and early clinical outcomes of performing on-pump cardiac surgery with the RenalGuard system. BACKGROUND: Acute kidney injury (AKI) is reported in up to 30% of patients undergoing cardiac surgery and is a recognised independent predictor of both morbidity and mortality. Forced diuresis with the RenalGuard system reduces the incidence of AKI during percutaneous coronary intervention procedures but its use in cardiac surgery has not been explored...
2017: Open Heart
https://www.readbyqxmd.com/read/29055710/remote-ischemic-preconditioning-in-high-risk-cardiovascular-surgery-patients-a-randomized-controlled-trial
#17
Nicole S Coverdale, Andrew Hamilton, Dimitri Petsikas, R Scott McClure, Paul Malik, Brian Milne, Tarit Saha, David Zelt, Peter Brown, Darrin M Payne
Remote ischemic preconditioning (RIPC) may reduce biomarkers of ischemic injury after cardiovascular surgery. However, it is unclear whether RIPC has a positive impact on clinical outcomes. We performed a blinded, randomized controlled trial to determine if RIPC resulted in fewer adverse clinical outcomes after cardiac or vascular surgery. The intervention consisted of 3 cycles of RIPC on the upper limb for 5 minutes alternated with 5 minutes of rest. A sham intervention was performed on the control group. Patients were recruited who were undergoing (1) high-risk cardiac or vascular surgery or (2) cardiac or vascular surgery and were at high risk of ischemic complications...
September 11, 2017: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29047417/levosimendan-for-patients-with-severely-reduced-left-ventricular-systolic-function-and-or-low-cardiac-output-syndrome-undergoing-cardiac-surgery-a-systematic-review-and-meta-analysis
#18
Filippo Sanfilippo, Joshua B Knight, Sabino Scolletta, Cristina Santonocito, Federico Pastore, Ferdinando L Lorini, Luigi Tritapepe, Andrea Morelli, Antonio Arcadipane
BACKGROUND: Previous studies have shown beneficial effects of levosimendan in high-risk patients undergoing cardiac surgery. Two large randomized controlled trials (RCTs), however, showed no advantages of levosimendan. METHODS: We performed a systematic review and meta-analysis (MEDLINE and Embase from inception until March 30, 2017), investigating whether levosimendan offers advantages compared with placebo in high-risk cardiac surgery patients, as defined by preoperative left ventricular ejection fraction (LVEF) ≤ 35% and/or low cardiac output syndrome (LCOS)...
October 19, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29045467/the-dose-of-hydroxyethyl-starch-6-130-0-4-for-fluid-therapy-and-the-incidence-of-acute-kidney-injury-after-cardiac-surgery-a-retrospective-matched-study
#19
Mona Momeni, Lompoli Nkoy Ena, Michel Van Dyck, Amine Matta, David Kahn, Dominique Thiry, André Grégoire, Christine Watremez
The safety of hydroxyethyl starches (HES) is still under debate. No studies have compared different dosing regimens of HES in cardiac surgery. We analyzed whether the incidence of Acute Kidney Injury (AKI) differed taking into account a weight-adjusted cumulative dose of HES 6% 130/0.4 for perioperative fluid therapy. This retrospective cohort study included all adult patients undergoing elective or emergency cardiac surgery with or without cardiopulmonary bypass. Exclusion criteria were patients on renal replacement therapy (RRT), cardiac trauma surgery, heart transplantation, patients with ventricular assist devices, subjects who required a surgical revision for bleeding and those whose medical records were incomplete...
2017: PloS One
https://www.readbyqxmd.com/read/29028633/acute-kidney-injury-in-congenital-heart-disease
#20
Katja M Gist, David M Kwiatkowski, David S Cooper
PURPOSE OF REVIEW: Acute kidney injury (AKI) is associated with significant morbidity and mortality in patients with congenital heart disease undergoing cardiac surgery or in pediatric patients with congestive heart failure. RECENT FINDINGS: This review describes the definition and various manifestations of AKI, the impact of biomarkers on the diagnosis of AKI, the importance of fluid overload as a consequence of AKI and its long-term impact. SUMMARY: There are novel biomarkers for AKI detection that should facilitate early recognition and intervention to prevent or attenuate the effects of AKI and fluid overload...
October 11, 2017: Current Opinion in Cardiology
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