Prevalence and risk factors of acute renal failure after cardiac surgery in Southern Iran

Acute renal failure requiring renal replacement therapy after cardiac surgery is still a cause of major morbidity and mortality worldwide. A number of risk factors for the development of acute renal injury after cardiac surgery have been previously described and based on these variables; several scoring algorithms were proposed. Predictive value of these algorithms in Iran is not described. This study investigates these risk factors among our patients in southern Iran. Two hundred and forty patients with normal kidney function who were candidates for cardiac surgery were enrolled and their baseline data were collected. Diabetes mellitus and age were selected as more controversial preoperative risk factors. Clamp and pump time were also selected as intra-operative risk factors and the type of operation was also considered as an independent risk factor. The patients were categorized in two groups including group 1: Patients with post-operation normal kidney function and group 2: Patients with post-operation ARF. All patients were followed with serial measurement of serum creatinine post-operation. The incidence of acute renal failure was 11.25%. Mean age of the patients in group 1 was 54.24 +/- 15.88 and in group 2 was 52.85 +/- 18.20 years. There was not any significant correlation between duration of clamp time and post operation acute renal failure. Clamp time in group 1 was 51.49 +/- 11.88 and in group 2 was 53.48 +/- 13.40 min. Duration of pump time in group 1 was 63.31 +/- 12.56 min and in group 2 was 78.07 +/- 10.85 min. The difference was statistically significant. Forty two [20%] of the patients in group 1 and 13 [50%] in group 2 were diabetic. Although several scoring algorithms are available for prediction of post-cardiac surgery complications, these can also be matched with our patients' criteria enhancing their accuracy for our situation

value of LDH level of BAL fluid in differentiating benign from malignant solitary pulmonary nodules

Serum lactate dehydrogenase [LDH] concentration is an indicator for tissue injury. It may be secreted locally in many conditions. For the first time, this study was performed to investigate the value of LDH level in bronchoalveolar lavage fluid [BALF] in differentiation of benign from malignant single pulmonary nodules [SPNs] and to assess its relationship with serum LDH levels. This study was a prospective case-control clinical study. It included 59 patients with a SPN and 21 non-smoker healthy adult volunteers as controls. They underwent bronchoscopy with BAL, Transbronchial needle aspiration [TBNA], and transbronchial biopsy [TBB]. Both total serum and HAL LDFJ levels were measured. The range of the HAL LDH levels in the control group was 4.60 -26 mild/mI, in patients with benign nodule was 6- 83 rnlU/ml, and in those with malignant nodule was 33 -147 mIU/ml. Overall, the mean BALF LDI-I level was significantly higher in patients with a malignant pulmonary nodule [85.92 +/- 28.31] as compared with that of either patients with a benign nodule [19.08 +/- 18.35] [p<0.0001] or control group [12.16 +/- 6.18] [p<0.0001]. No significant difference between the absolute value of HAL LDH level in patients with benign pulmonary nodule and the control subjects was found [p=0.23]. There was no correlation between HALF LDH and serum LDFI level in patients with SPNs [p=0.595]. HALF LDH levels are increased in patients with malignant SPN, but had no significant rise in benign solitary pulmonary nodules. This factor is useful in differentiating benign from malignant SPNs. A low BAL fluid LDI-1 level in a patient with SPN who does not have a tissue diagnosis may be deemed acceptable for observation and follow up. This may save patients the need for operative procedures