Assessment of subclinical acute kidney injury after abdominal aortic aneurysm surgery using novel markers: L-FABP and H-FABP

Background: One of the most severe complications of repair surgery for abdominal aortic aneurysms (AAA) is acute kidney injury (AKI). Even small rises in serum creatinine are associated with increased mortality. The aim of this study was to assess the dynamics of AKI after elective AAA surgery using novel markers. Methods: The study group consisted of 22 patients with AAA. We measured urinary liver- (u-L-FABP) and heart-type fatty acid-binding proteins (u-H-FABP) before, during and within 3 days after surgery. Results: We found an abrupt and significant elevation of both urine FABPs normalized to urinary creatinine; u-L-FABP reached its peak value 2 hours after aortic clamp release {137.79 (38.57-451.79) vs. 9.94 (6.82-12.42) ng/mg baseline value, p<0.05; values are medians (lower-upper quartile)}. The peak value of u-H-FABP was reported 72 hours after aortic clamp release {16.462 (4.182-37.595) vs. 0.141 (0.014-0.927) ng/mg baseline value, p<0.05}. The serum creatinine level did not changed significantly during the investigation period. Conclusions: The significant rise of both u-L-FABP and u-H-FABP after AAA surgery indicates renal proximal and distal tubule injury in this population. Our results suggest that, after AAA surgery, the distal tubules could be more affected than the proximal ones. u-FABPs could serve as sensitive biomarkers of kidney tubular injury and may allow to detect the very early phases of AKI (AU)

Antecedentes: Una de las complicaciones más graves de la cirugía reparatoria de aneurisma aórtico abdominal (AAA) es el fracaso renal agudo (FRA). Incluso un pequeño ascenso de creatinina sérica se asocia a un aumento de la mortalidad. El objetivo de este estudio ha sido valorar la dinámica del FRA después de cirugía electiva de AAA utilizando nuevos marcadores. Métodos: En el estudio se incluyeron 22 pacientes con AAA. Medimos la proteína hepática transportadora de ácidos grasos (u-L-FABP) y la proteína cardíaca transportadora de ácidos grasos (u-h-FABP) en orina, antes, durante y dentro de los tres días siguientes a la cirugía. Resultados: Se observó una brusca y significativa elevación de ambas FABP en orina, normalizada a creatinina en orina; el nivel de u-L-FABP alcanzó su pico dos horas después de quitar la abrazadera aórtica {137,79 (38,57-451,79) frente a 9,99 (6,82-12,42) ng/mg del valor basal p < 0,05; los valores son medianos (cuartil inferior-superior)}. El pico de la u-H-FABP se notó 72 horas después de quitar la abrazadera aórtica {16,462 (4,182-37,595) frente a 0,141 (0,014-0,927) ng/mg del valor basal}. El nivel de creatinina sérica no cambió de manera significativa durante el período de estudio. Conclusiones: El aumento significativo de ambas u-L-FABP y u-H-FABP después de cirugía de AAA indica la lesión tubular renal distal y proximal en la población estudiada. Nuestros resultados sugieren que después de una cirugía de AAA el túbulo distal puede ser más afectado que el proximal. Las u-FABP podrían servir como biomarcadores sensitivos de la lesión tubular renal y permitir detectar la fase más precoz de FRA (AU)

Assessment of subclinical acute kidney injury after abdominal aortic aneurysm surgery using novel markers: L-FABP and H-FABP.

BACKGROUND: One of the most severe complications of repair surgery for abdominal aortic aneurysms (AAA) is acute kidney injury (AKI). Even small rises in serum creatinine are associated with increased mortality. The aim of this study was to assess the dynamics of AKI after elective AAA surgery using novel markers. METHODS: The study group consisted of 22 patients with AAA. We measured urinary liver- (u-L-FABP) and heart-type fatty acid-binding proteins (u-H-FABP) before, during and within 3 days after surgery. RESULTS: We found an abrupt and significant elevation of both urine FABPs normalized to urinary creatinine; u-L-FABP reached its peak value 2 hours after aortic clamp release {137.79 (38.57-451.79) vs. 9.94 (6.82-12.42) ng/mg baseline value, p<0.05; values are medians (lower-upper quartile)}. The peak value of u-H-FABP was reported 72 hours after aortic clamp release {16.462 (4.182-37.595) vs. 0.141 (0.014-0.927) ng/mg baseline value, p<0.05}. The serum creatinine level did not changed significantly during the investigation period. CONCLUSIONS: The significant rise of both u-L-FABP and u-H-FABP after AAA surgery indicates renal proximal and distal tubule injury in this population. Our results suggest that, after AAA surgery, the distal tubules could be more affected than the proximal ones. u-FABPs could serve as sensitive biomarkers of kidney tubular injury and may allow to detect the very early phases of AKI.

Churg-Strauss syndrome and congenital factor Leiden thrombophilia as nontypical causes of intracardiac thrombosis.

We present and discuss the case of a 26-year-old man suffering from Churg-Strauss syndrome (CSS). In our patient the disease severely affected both the heart and the lungs. Left ventricular dysfunction and intracardiac thrombosis, probably secondary to the cardiotoxic effect of eosinophils, were revealed by echocardiography. The risk of thrombosis was additionally increased by the coexistence of the factor V Leiden gene mutation. An opportunely established diagnosis allowed institution of an appropriate pharmacotherapy and subsequently to obtain a significant abatement of the clinical symptoms as well as the laboratory manifestations of the disease.

[Clinical characteristics of 33 patients with adrenal incidentaloma]. / Analiza kliniczna 33 chorych z bezobjawowym guzem nadnerczy (incidentaloma).

UNLABELLED: Incidentally diagnosed, clinically asymptomatic adrenal masses (incidentaloma) have become more and more common problem in everyday clinical practice. The prevalence of such tumors is 2.3% in autopsy series and 0.5-2% in computed tomography series. The aim of the study was a clinical analysis of patients with adrenal incidentaloma, hospitalized in the Department of Internal and Metabolic Diseases of the Medical University of Silesia. MATERIAL AND METHODS: 33 patients, including 25 females (75.7%) and 8 males (24.3%), were investigated. The mean age was 59.0 +/- 10.7 year (31-80) and the mean body mass index (BMI) was 29.6 +/- 5.9 kg/m2 (19.4-47). RESULTS: 16 patients (48.5%) were obese and 10 more patients (30.3%) were overweight. Hypertension was diagnosed in 25 patients (75.8%), diabetes or impaired glucose tolerance in 9 patients (27.3%) and hyperlipidemia in 20 patients (60.6%). Endocrine tests revealed: disturbed cortisol rhythm in 1 patient, uncertain result of the overnight dexamethasone suppression test in 4 patients, elevated urinary 17-hydroxycorticosteroids excretion in 7 patients, elevated urinary 17-ketosteroids excretion in 2 patients and increased urinary excretion ofvanillylmandelic acid in 2 patients. The tumor was located in the right adrenal gland in 13 patients (39.4%) and in the left adrenal gland in 16 patients (48.5%). 4 patients (12.1%) demonstrated bilateral adrenal masses. At least one of the tumor sizes was greater than 40 mm in 3 patients (9.1%). CONCLUSION: Clinically asymptomatic adrenal tumors occurred more frequently in overweight or obese women, between 51-70 years old, with lipid disorders and hypertension.