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. 2025 Jul-Sep;47(3):e20240173.
doi: 10.1590/2175-8239-JBN-2024-0173en.

Urinary and serum biomarkers of renal injury in coronary artery bypass grafting: a prospective evaluation with new biomarkers'

[Article in English, Portuguese]
Antônio Felipe Leite Simão  1   2   3 , Gdayllon Cavalcante Meneses  4   5   6 , Lia Cavalcante Cezar  7 , Letícia Machado de Araújo  4   6 , Alice Maria Costa Martins  4   6 , Heraldo Guedis Lobo Filho  1   7   2 , Bruna Viana Barroso Martins  4   6 , Geraldo Bezerra da Silva Júnior  8 , Elizabeth De Francesco Daher  8 , José Glauco Lobo Filho  7
Affiliations

Urinary and serum biomarkers of renal injury in coronary artery bypass grafting: a prospective evaluation with new biomarkers'

[Article in English, Portuguese]
Antônio Felipe Leite Simão et al. J Bras Nefrol. 2025 Jul-Sep.

Abstract
in English, Portuguese

Introduction: Cardiopulmonary bypass (CPB) for coronary artery bypass grafting (CABG) often causes kidney dysfunction and increases morbidity and mortality.

Aims: To evaluate the effects of CPB on kidney structures of patients submitted to CABG using serum and urinary biomarkers.

Methods: This prospective study included patients who underwent CABG over a 14-month period. Data related to clinical, surgical, and laboratory were collected. The glomerular filtration rate was estimated using the CKD-EPI equation. The urinary biomarkers trialed were nephrin, KIM-1, MCP-1, Syndecan-1, and NGAL.

Results: Out of 30 patients enrolled, 22 were assessed. The mean age was 65 years and most were male. During CABG, the On-pump group had increased urinary nephrin (p = 0.007) and urinary (p = 0.036) and serum NGAL (p = 0.030) levels compared to the Off-pump group. Moreover, intraoperatively, in the On-Pump clusters, the urinary NGAL was correlated with the decrease of glomerular filtration rate in the first 48 hours after CABG (Rho = - 0.838, p = 0.009). There was no statistical difference in clinical and surgical aspects between groups according to use of CBP during CABG.

Conclusion: CBP procedure used during CABG was associated with relevant effects on kidney structure, such as podocyte and tubular injury. Urinary NGAL was able to predict an impairment of glomerular filtration 48 hours after CABG.

Introdução:: A circulação extracorpórea (CEC) para cirurgia de revascularização do miocárdio (CRM) frequentemente causa disfunção renal e aumento da morbimortalidade.

Objetivos:: Avaliar os efeitos da CEC nas estruturas renais de pacientes submetidos à CRM, por meio de biomarcadores séricos e urinários.

Métodos:: Este estudo prospectivo incluiu pacientes submetidos à CRM em um período de 14 meses. Foram coletados dados clínicos, cirúrgicos e laboratoriais. A taxa de filtração glomerular foi estimada pela equação CKD-EPI. Os biomarcadores urinários avaliados foram nefrina, KIM-1, MCP-1, Syndecan-1 e NGAL.

Resultados:: Dos 30 pacientes inscritos, 22 foram avaliados. A idade média foi de 65 anos e a maioria era do sexo masculino. Durante a CRM, o grupo On-pump apresentou níveis aumentados de nefrina urinária (p = 0,007), NGAL urinária (p = 0,036) e sérica (p = 0,030) em comparação ao grupo Off-pump. Além disso, no período intraoperatório, nos grupos On-pump, a NGAL urinária foi correlacionada com a redução da taxa de filtração glomerular nas primeiras 48 horas após a CRM (Rho = −0,838; p = 0,009). Não houve diferença estatística entre os grupos quanto aos aspectos clínicos e cirúrgicos de acordo com o uso da CEC durante a CRM.

Conclusão:: O uso do procedimento de CEC durante a CRM esteve associado a efeitos relevantes na estrutura renal, como lesão tubular e de podócitos. A NGAL urinária foi capaz de predizer o comprometimento da filtração glomerular 48 horas após a CRM.

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Conflict of interest statement

Conflict of Interest: No conflict of interest.

Figures

Figure 1
Figure 1. Measurements of kidney and endothelial biomarkers. Notes: Images obtained from public sources and under Creative Commons license: [1] https://images.app.goo.gl/hVp4Kq5j3sosjRiX7; [2] https://images.app.goo.gl/z2RinjcSy1JAVZFb9; [3] https://images.app.goo.gl/U5FMjAxiBUx8S2ok6; [4] https://commons.wikimedia.org/w/index.php?curid=12484442; [5] https://commons.wikimedia.org/wiki/File:Blausen_0468_Heart-Lung_Machine.png; [6] https://commons.wikimedia.org/w/index.php?curid=4489929.
Figure 2
Figure 2. Urinary NGAL, urinary nephrin, and serum NGAL significantly increased during the surgery in On-pump group.
Figure 3
Figure 3. Correlation between uNGAL level during CABG and variation in GFR in the first 48h post-surgery.
Figura 1
Figura 1. Medições de biomarcadores renais e endoteliais. Notas: Imagens obtidas de fontes públicas e sob licença Creative Commons: [1] https://images.app.goo.gl/hVp4Kq5j3sosjRiX7; [2] https://images.app.goo.gl/z2RinjcSy1JAVZFb9; [3] https://images.app.goo.gl/U5FMjAxiBUx8S2ok6; [4] https://commons.wikimedia.org/w/index.php?curid=12484442; [5] https://commons.wikimedia.org/wiki/File:Blausen_0468_Heart-Lung_Machine.png; [6] https://commons.wikimedia.org/w/index.php?curid=4489929.
Figura 2
Figura 2. A NGAL urinária, a nefrina urinária e a NGAL sérica aumentaram significativamente durante a cirurgia no grupo on-pump.
Figura 3
Figura 3. Correlação entre o nível de NGAL urinária durante a CRM e a variação da TFG nas primeiras 48 horas após a cirurgia.
See this image and copyright information in PMC

References

    1. Joynt Maddox KE, Elkind MSV, Aparicio HJ, Commodore-Mensah Y, de Ferranti SD, Dowd WN, et al. Forecasting the burden of cardiovascular disease and stroke in the united states through 2050: prevalence of risk factors and disease: a presidential advisory from the American Heart Association. Circulation. 2024;150(4):e65–88. doi: 10.1161/CIR.0000000000001256. - DOI - PubMed
    1. Schurle A, Koyner JL. CSA-AKI: incidence, epidemiology, clinical outcomes, and economic impact. J Clin Med. 2021; 10(24):5746. doi: 10.3390/jcm10245746. - DOI - PMC - PubMed
    1. Wang X, Guo N, Chen Y, Dai H. A new model to predict acute kidney injury after cardiac surgery in patients with renal insufficiency. Ren Fail. 2022;44(1):767–76. doi: 10.1080/0886022X.2022.2071297. - DOI - PMC - PubMed
    1. Mao H, Katz N, Ariyanon W, Blanca-Martos L, Adýbelli Z, Giuliani A, et al. Cardiac surgery-associated acute kidney injury. Cardiorenal Med. 2013;3(3):178–99. doi: 10.1159/000353134. - DOI - PMC - PubMed
    1. Dasta JF, Kane-Gill SL, Durtschi AJ, Pathak DS, Kellum JA. Costs and outcomes of acute kidney injury (AKI) following cardiac surgery. Nephrol Dial Transplant. 2008;23(6):1970–4. doi: 10.1093/ndt/gfm908. - DOI - PubMed