Importance of Urinary Measurement of Glutathione S-Transferase in Renal Dysfunction Patients after On- and Off-Pump Coronary Artery Bypass Surgery

Abstract

Background: Acute renal failure (ARF) occurring after on-pump and off-pump cardiac surgery was assessed by urinary alpha glutathione S-transferase measurement (α‐GST) in patients who already had renal dysfunction.

Methods: Fifty-one patients with plasma creatinine levels ranging between 1.5 and 2.0 mg/dL were included in the study. On-pump coronary artery bypass was performed in 25 of them, and off-pump surgery in the other 25 patients. Urinary α‐GST levels, plasma creatinine levels, creatinine clearance and fractional excretion of sodium were measured.

Results: Urinary α‐GST levels were found to be significantly increased at 24 hours postoperatively. A weak correlation was detected between α‐GST levels and plasma creatinine, creatinine clearance and fractional excretion of sodium. Preoperative and postoperative 24 hour levels showed a positive predictive value for the occurrence of acute renal failure.

Conclusions: Tubular damage produced by cardiopulmonary bypass is not the only factor associated with postoperative ARF. Because factors independent of pump usage can adversely affect renal function, excluding pump usage alone is not sufficient to prevent postoperative ARF in patients who have preoperative renal dysfunction.

cardiovascular surgery - coronary bypass surgery - heart disease

References

• 1 Bell M, Liljestam E, Granath F, Fryckstedt J, Ekbom A, Martling C R. Optimal follow-up time after continuous renal replacement therapy in actual renal failure patients stratified with the RIFLE criteria.  Nephrol Dial Transplant. 2005;  20 354-360
• 2 Rosner M H, Okusa M D. Acute kidney injury associated with cardiac surgery.  Clin J Am Soc Nephrol. 2006;  1 19-32
• 3 Chertow G M, Levy E M, Hammermeister K E, Grover F, Daley J. Independent association between acute renal failure and mortality following cardiac surgery.  Am J Med. 1998;  104 343-348
• 4 Conlon P J, Stafford-Smith M, White W D. et al . Acute renal failure following cardiac surgery.  Nephrol Dial Transplant. 1999;  14 1158-1162
• 5 Mangano C M, Diamondstone L S, Ramsay J G, Aggarwal A, Herskowitz A, Mangano D T. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. The Multicenter Study of Perioperative Ischemia Research Group.  Ann Intern Med. 1998;  128 194-203
• 6 Meldrum D R, Donnahoo K K. Role of TNF in mediating renal insufficiency following cardiac surgery: evidence of a post-bypass cardiorenal syndrome.  J Surg Res. 1999;  85 185-199
• 7 Block C A, Manning H L. Prevention of acute renal failure in the critically ill.  Am J Respir Crit Care Med. 2002;  165 320-324
• 8 Venkatachalam M A, Bernard D B, Donohoe J F, Levinsky N G. Ischemic damage and repair in the rat proximal tubule: differences among the S1, S2, and S3 segments.  Kidney Int. 1978;  14 31-49
• 9 Thakar C V, Arrigain S, Worley S, Yared J P, Paganini E P. A clinical score to predict acute renal failure after cardiac surgery.  J Am Soc Nephrol. 2005;  16 162-168
• 10 Thakar C V, Worley S, Arrigain S, Yared J P, Paganini E P. Influence of renal dysfunction on mortality after cardiac surgery: modifying effect of preoperative renal function.  Kidney Int. 2005;  67 1112-1119
• 11 Beauford R B, Saunders C R, Niemeier L A. et al . Is off-pump revascularization better for patients with non-dialysis-dependent renal insufficiency?.  Heart Surg Forum. 2004;  7 E141-E146
• 12 Bucerius J, Gummert J F, Walther T. et al . On-pump versus off-pump coronary artery bypass grafting: impact on postoperative renal failure requiring renal replacement therapy.  Ann Thorac Surg. 2004;  77 1250-1256
• 13 Branten A J, Mulder T P, Peters W H, Assmann K J, Wetzels J F. Urinary excretion of glutathione S transferases alpha and pi in patients with proteinuria: reflection of the site of tubular injury.  Nephron. 2000;  85 120-126
• 14 Harrison D J, Kharbanda R, Cunningham D S, McLellan L I, Hayes J D. Distribution of glutathione S-transferase isoenzymes in human kidney: basis for possible markers of renal injury.  J Clin Pathol. 1989;  42 624-628
• 15 Feinfeld D A, Fleischner G M, Arias I M. Urinary ligandin and glutathione-S-transferase in gentamicin-induced nephrotoxicity in the rat.  Clin Sci (Lond). 1981;  61 123-125
• 16 Westhuyzen J, Endre Z H, Reece G, Reith D M, Saltissi D, Morgan T J. Measurement of tubular enzymuria facilitates early detection of acute renal impairment in the intensive care unit.  Nephrol Dial Transplant. 2003;  18 543-551
• 17 Di Mauro M, Gagliardi M, Iaco A L. et al . Does off-pump coronary surgery reduce postoperative acute renal failure? The importance of preoperative renal function.  Ann Thorac Surg. 2007;  84 1496-1502
• 18 Shemesh O, Golbetz H, Kriss J P, Myers B D. Limitations of creatinine as a filtration marker in glomerulopathic patients.  Kidney Int. 1985;  28 830-838
• 19 Cressey G, Roberts D R, Snowden C P. Renal tubular injury after infrarenal aortic aneurysm repair.  J Cardiothorac Vasc Anesth. 2002;  16 290-293
• 20 Eijkenboom J J, van Eijk L T, Pickkers P, Peters W H, Wetzels J F, van der Hoeven H G. Small increases in the urinary excretion of glutathione S-transferase A1 and P1 after cardiac surgery are not associated with clinically relevant renal injury.  Intensive Care Med. 2005;  31 664-667