Acute kidney injury (AKI) is often a disastrous consequence of surgeries. It is preventable and yet, in case it happens, the results are more often than not, fatal. Scientists have been trying for long to identify the characteristics which make certain patients more prone to develop AKI. Now, two studies which will be published in the upcoming issue of the “Journal of the American Society of Nephrology,” have identified three proteins which may give a clue about the impending AKI in patients following heart surgery. The two studies have been identified as the largest studies conducted till date to compare and corroborate the usefulness of the three proteins.
More than 1200 adults and 300 children scheduled for heart surgeries, throughout North America, were included in the studies. The levels of three proteins namely, urine interleukin-18 (IL-18) and urine and plasma (blood) neutrophil gelatinase-associated lipocalin (NGAL) were assessed at regular intervals by drawing frequent urine and blood samples. Their ability to predict kidney injury after surgery was also assessed.
It was seen that participants with the highest level of urine interleukin-18 were six times more likely to develop kidney injury following heart surgery. GAL levels in plasma of adults were also a good biomarker of impending kidney disease in adults. However, urine NGAL levels were not able to predict accurately the likelihood of developing AKI in adults. In children, urine NGAL was a good biomarker of AKI whereas plasma NGAL was not found to be that accurate.
Earlier, serum creatinine was used as a marker of kidney damage. However, the results were often inaccurate as creatinine gave a delayed result. Early damage to the kidney often went unnoticed. According to author Chirag Parikh, MD, PhD (Yale University School of Medicine), the three proteins identified in the present studies identify kidney injury soon after surgery and 24 to 48 hours earlier than creatinine. When measured immediately after surgery, they are pretty accurate in predicting kidney damage. When identified earlier, these patients may be subjected to treatment modalities to protect their kidneys.
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