Despite the improvement in surgical techniques, anesthesia and post operative care, cardiac surgery with the use of extra corporal circulation is associated with oxidative stress.(Gerristen,W.B. etal.,1997; Matata,B.M.et al.,2000) 6, 23 As a response to oxidative stress, the systemic inflammation is enhanced that leads to AKI, which is one of the most important post cardio thoracic complications. ( Baker,W. etal., 2009) 24 The timely and early diagnosis of AKI is imperative to institute therapeutic strategies to significantly improve the patients outcome. The various limitations of using serum creatinine and urine output, for diagnosing AKI, have stimulated an intensive evaluation of alternative early biomarkers of AKI. Although there have been many biomarkers of AKI under investigation, most of the current interest has focused mainly on NGAL.
Studies by Devarajan et al, has brought NGAL to the forefront as an early and reliable biomarker of AKI, compared to other markers such as cystatin C and IL-18. ( Devarajan,P. 2007; Mishra,J.et al., 2003; Devrajan,P. et al., 2003; Haase-Fielitz,A. et al.,2009) 12, 15, 16, 25 When our study was initiated a couple of years before, there was no documented data to validate the potential role of plasma NGAL as a biomarker in adults undergoing CABG with CPB and its association with oxidative stress.
Human NGAL ,a member of lipocalin superfamily is a 25 kDa protein, covalently bound to gelatinase in neutrophils and expressed at low concentrations in normal kidney, lungs, stomach, trachea and colon. Our data clearly indicate that plasma NGAL is a potent early biomarker of AKI, which precedes the increase in serum creatinine by several hours as reported earlier. The early increase in the l...
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...ng renal injury, diabetes and nephrotoxic drugs should have been considered to potentially identify the risk factors thatt predispose the patient to AKI post operatively. Third, even though the plasma NGAL may be more useful in early detection of renal injury, simultaneous analysis of urinary NGAL if carried out may be more meaningful in renal function assessment.
In conclusion, our study demonstrated that increased plasma NGAL concentrations are associated with an increased occurrence of post operative AKI in adult patients undergoing CABG with CPB. The oxidative stress as measured by the levels of MDA and enzymatic antioxidants as biomarkers is not associated with AKI. To validate the possibility of plasma NGAL as a screening tool for AKI during cardiac surgeries, a multi centre trial in a large cohort of patients should be undertaken.
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