Neutrophil gelatinase-associated lipocalin as emerging biomarker of acute renal failure in renal transplant patient after coronary artery bypass surgery.

Acute renal injury (AKI) is a serious complication, which increases the risk of death after cardiac surgery. Although serum Cre is typically used for diagnosis of AKI, there are disadvantages in its use as renal marker. Neutrophil gelatinase-associated lipocalin (NGAL) is a protein of the lipocalin family and is expressed by neutrophils and other epithelial cells including segments of proximal collecting tubule (PCT). It is introduced as an excellent renal biomarker, for the early diagnosis of AKI in children and adults undergoing renal transplantation and cardiac surgery. According to literature data NGAL is detected in the very first urine sample within two hours following ischemia. It is one of the earliest and most robustly induced proteins in kidneys following ischemic and nephrotoxic insults. We present an interesting case of renal transplant patient under long-term immunosuppressive therapy. He had already renal impairment of the transplant kidney (GFR 29.3 mL/min/1.73 m(2)). He suffered from coronary artery disease without history of myocardial infraction and underwent elective coronary artery bypass grafting (CABG). Renal function was monitored also with NAGL, in order to avoid potential renal graft failure postoperatively.

Endovascular treatment of symptomatic and ruptured abdominal aortic aneurysms.

AIM: To report our early experience with endovascular treatment of symptomatic and ruptured abdominal aortic aneurysms (AAA) using the Talent bifurcated stent graft. PATIENTS-METHODS: From August 2003 to May 2007 nine patients with symptomatic AAA (sAAA) (two after previous endovascular repair and endoleak), and eleven patients with ruptured AAA (rAAA) (one with ruptured iliac aneurysm and one with spontaneous aortic rupture) were treated endovascularly. Seven bifurcated stent grafts, (six Talent), and two iliac extensions were implanted into the patients with sAAA, and nine bifurcated stent grafts (eight Talent) and two aorto-uniliacs were implanted into the patients with rAAA. RESULTS: The deployment of the endovascular device in the intended location was successful in all patients. There was no conversion to open surgery. One patient with sAAA died after stroke and sepsis resulting in 11.1% 30-day mortality in this group. One required re-intervention for a type I endoleak before his discharge. Eight patients were discharged and during a follow-up period of 4-42 months (median 18 months) they have remained well. Two patients with rAAA died in the 30-day postoperative period. Thirty-day mortality was 18.1%. An unintended occlusion of one renal artery was performed. There were 9 survivors. During a follow-up period of 17-45 months (median 26 months) one more died of myocardial infarction. CONCLUSION: Initial experience with endovascular treatment of patients with symptomatic or ruptured AAA, using the Talent bifurcated stent graft is promising. Bifurcated endografts can be implanted into patients with rAAA. A larger number of patients and longer follow-up is necessary to arrive at more reliable conclusions.