Ocena ledvične funkcije s cistatinom C pri bolnikih, operiranih na koronarnih arterijah : magistrska naloga

Šter, Mateja (author), Osredkar, Joško (mentor), Skitek, Milan (comentor)

Po premostitvenih operacijah koronarnih arterij, ki so najpogostejša vrsta srčnih operacij, prihaja do akutnih ledvičnih okvar za katere je potrebno nadomestno zdravljenje v 1–5 %. Povezane so z zelo veliko stopnjo obolevnosti in umrljivosti. Za ta resen klinični problem je zato priporočeno spremljanje ledvične funkcije po operaciji. Standardni parametri za oceno ledvične funkcije v klinični praksi so koncentracija kreatinina v serumu, izmerjeni očistek kreatinina in v novejšem času ocena hitrosti glomerulne filtracije (GFR) z enačbo raziskave MDRD, ki pa vsi temeljijo na meritvi kreatinina v serumu, na katero vpliva veliko dejavnikov povezanih s tvorbo in izločanjem kreatinina ter metodo določanja. V našo nalogo smo vključili tudi novejši označevalec ledvične funkcije, cistatin C in izračunano oceno GFR iz cistatina C. Izvedli smo prospektivno in delno randomizirano raziskavo, v katero je bilo vključenih 50 bolnikov, polovica je bila tistih, ki so bili operirani na koronarnih arterijah z zunajtelesnim krvnim obtokom (ZTKO) in druga polovica je bila pri operaciji brez ZTKO. Ledvično funkcijo bolnikov smo spremljali 5 zaporednih dni; od predoperativnega dne do 3. dne po operaciji. Obe skupini bolnikov sta bili pred operacijo podobni, razlikovali sta se le v številu zožitev koronarnih arterij. Med in po operaciji ni bilo večjih kliničnih zapletov oziroma incidentov, kot je možganski infarkt ali smrt. Noben bolnik po operaciji ni potreboval dializnega zdravljenja. Pri štirih bolnikih, kar je 8 % od vseh vključenih bolnikov v raziskavo, se je razvila 1. stopnja akutne ledvične okvare, imenovana tveganje za okvaro, ki je bila definirana po RIFLE kriterijih. Dva bolnika sta bila operirana z uporabo ZTKO in dva brez. Pri skupini bolnikov operiranih z uporabo ZTKO je prišlo do statistično pomembnega, vendar subkliničnega zmanjšanja GFR. Bolniki operirani brez uporabe ZTKO so imeli stabilno GFR po operaciji, kar kaže na neprizadeto ledvično funkcijo. Zmanjšano ledvično funkcijo (GFR) po operaciji z uporabo ZTKO smo dokazali s kreatininom, cistatinom C ter izračunanima ocenama GFR iz obeh serumskih označevalcev. Izmerjeni očistki kreatinina so bili nezanesljivi, predvsem zaradi netočnega zbiranja dnevnega urina, obenem pa precenjujejo GFR, ker se kreatinin izloča v urin tudi v tubulih ledvic.

• Language: Slovenian
• Keywords: ishemična srčna bolezen kreatinin cistatin C GFR premostitvena operacija koronarne arterije
• Work type: Master's thesis
• Typology: 2.09 - Master's Thesis
• Organization: FFA - Faculty of Pharmacy
• Place of publishing: Ljubljana
• Publisher: [M. Šter]
• Year: 2009
• Number of pages: 54 f.
• PID: 20.500.12556/RUL-121346
• UDC: 616.1
• COBISS.SI-ID: 2732145
• Publication date in RUL: 05.10.2020

Secondary language

• Language: English
• Title: Assessment of kidney function with cystatin C at patients, after coronary arteries operations

Abstract

After coronary artery bypass grafting, which are the most common types of cardiac surgery, develops acute renal injury requiring replacement therapy in 1–5 %. They are associated with high rates of morbidity and mortality. For this relevant clinical problem, it is recommended to monitor renal function after surgery. Standard parameters for investigating renal function in clinical routine are serum creatinine, measured creatinine clearance and in present time a prediction equation to estimate glomerular filtration rate (GFR) from serum creatinine by the MDRD study equation, but they all are based on measurement of serum creatinine, which is influenced by a lot of factors such as formation and excretion of creatinine and method of determination. In our study we included also a new marker of renal function serum cystatin C and predicted estimate GFR from serum cystatin C. We performed a prospective and partly randomized trial in 50 patients, half of the patients were operated on coronary arteries with cardiopulmonary bypass and the other half of patients were operated without cardiopulmonary bypass. Renal function was assessed 5 consecutive days; from preoperative day up to third postoperative day. Both patients groups were similar preoperatively, except they had different number of coronary arteries affected. During and after surgery there were no serious complications like myocardial infarct or death. No patients required postoperative dialysis support. Four patients, which are 8 % of all patients included in the study, developed acute renal injury class Risk for injury by RIFLE classification. Two of them were operated with cardiopulmonary bypass and two without it. Patients operated with cardiopulmonary bypass developed statistically significant but subclinical reduced GFR. Patients operated without cardiopulmonary bypass had stable GFR after surgery and uninjured renal function. Reduced renal function (GFR) after surgery with cardiopulmonary bypass we demonstrated with serum creatinine, cystatin C and calculated estimation of GFR from both serum markers. Measured creatinine clearances were unreliable, mainly because of imprecise collecting of timed urine samples and they also overestimate GFR, because creatinine is also secreted in urine by renal tubules.