Katie E. Rollins1, Ayesha Noorani1, Keith Burling2, Jonathan Boyke1
1Department of Vascular Surgery, Addenbrookes Hospital, Cambridge, United Kingdom; 2Addenbrookes Hospital ̶ Department of Chemical Pathology, Cambridge, United Kingdom.
OBJECTIVES: Endovascular aneurysm repair (EVAR) is less invasive and has fewer complications than open surgery but introduces the risk of peri-operative renal injury due to a combination of guidewire manipulation within the aorta and contrast induced nephropathy (CIN). In this setting of pre-clinical renal failure traditional measures of renal function are relatively insensitive. Newer markers of subclinical renal injury exist, but are mostly used within the research setting. We aim to establish the sensitivity of a range of biomarkers for renal injury in an in-vivo human clinical study.
METHODS: Using elective EVAR as a model, sixteen patients were recruited into the study between December 2009 and April 2010. Urine was collected pre-operatively then at 6, 12, 24 and 48 hours and tested for biomarkers of renal damage (N-GAL, Interleukin-18, retinol binding protein and albumin creatinine ratio). Serum creatinine and eGFR were calculated at all-time points.
RESULTS: Sixteen patients (12 male), median age 80 years (range 69-87) underwent EVAR. The novel biomarkers for subclinical renal damage were raised within the initial 12-hour period post-operatively, however no markers showed significant elevation at subsequent time points. At 12 hours postoperatively there was a significant rise in urinary NGAL (p=0.0029) and IL-18 levels (p=0.0305). Urinary creatinine was significantly raised at 6 hours (p=0.0345) but at no other time points. Serum creatinine was no different at 24 hours but elevated with borderline significance (p=0.062) at 48 hours.
CONCLUSIONS: N-GAL and IL-18 appear to be sensitive markers for renal injury in the initial 12 hours following EVAR. Traditional measures of renal damage did not become elevated before 48 hours postoperatively. These urinary biomarkers are potential useful predictors of renal injury and may be used to assess the effectiveness of therapeutic strategies aimed at ameliorating CIN during EVAR.
AUTHOR DISCLOSURES: J. Boyke, Nothing to disclose; K. Burling, Nothing to disclose; A. Noorani, Nothing to disclose; K. E. Rollins, Nothing to disclose.
Posted April 2012