The evaluation of acute kidney injury due to ischemia by urinary neutrophil gelatinase-induced lipocalin (uNGAL) measure
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UROLOGY - ORIGINAL PAPER
The evaluation of acute kidney injury due to ischemia by urinary neutrophil gelatinase‑induced lipocalin (uNGAL) measurement in patients who underwent partial nephrectomy Cagri Akpinar1 · Ozlem Dogan2 · Eralp Kubilay1 · Mehmet Ilker Gokce1 · Evren Suer1 · Omer Gulpinar1 · Sumer Baltaci1 Received: 15 July 2020 / Accepted: 18 September 2020 © Springer Nature B.V. 2020
Abstract Purpose To investigate the role of urinary neutrophil gelatinase-induced lipocalin (uNGAL) measurement in the early diagnosis of acute kidney injury that may occur after intraoperative ischemia in patients undergoing partial nephrectomy (PN). Methods This prospective study included 86 patients who underwent open laparoscopic or robotic partial nephrectomy between May 2017 and May 2019. During the surgery, whether the patients had ischemia or not, type of vascular clamping and the ischemia time were noted. The definition of acute kidney injury (AKI) was classified according to Acute Kidney Injury Network (AKIN) criteria. Urine samples were collected preoperatively and 3 h after renal pedicle clamp removal and uNGAL was measured. Results AKI was recorded in 34 (39.5%) of 86 patients after PN. Of the 34 patients, 26 (76.4%) had level 1 and 8 (23.6%) had level 2 AKI. uNGAL levels increased significantly as an early reflection of AKI in patients who underwent intraoperative total or renal artery clamping (p = 0.024). There was no significant postoperative increase in uNGAL in the non-ischemic group (p = 0.163). uNGAL expression was detected well before serum creatinine increase. Patients with AKI after PN had higher uNGAL expression (p = 0.008) However, there was no correlation between the level of AKI and uNGAL expression (r = 0.201, p = 0.066). Conclusion Ischemic acute kidney injury after nephron-sparing surgery can be detected early by uNGAL measurement. In future studies comparing outcomes of different surgical techniques on renal functions after PN, uNGAL levels may be used. Keywords Partial nephrectomy · NGAL · Acute kidney injury · Ischemia
Introduction Due to the high incidence of chronic kidney disease (CKD) after radical nephrectomy (RN), partial nephrectomy (PN) is the preferred treatment method for most localized kidney tumors today [1]. PN is a surgery that requires temporary renal pedicle clamping, which can often result in acute kidney injury (AKI) [2, 3]. AKI is an important complication developing in approximately 30% of patients after surgery * Cagri Akpinar [email protected] 1
Department of Urology, School of Medicine, Ibn-i Sina Hospital, Ankara University, Ankara, Turkey
Department of Biochemistry, Ankara University, Ankara, Turkey
2
[4], and it is an important risk factor for non-cancer related mortality and cardiovascular disease related morbidity [5]. Therefore, prevention of functional tissue damage during PN is very important for these patients. Serum creatinine (sCre) level is taken into account for evauation of AKI in various conditions. However, it is known that sCre
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