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renal protection in major surgery

Ioannis Bellos, Dimitrios C Iliopoulos, Despina N Perrea
BACKGROUND: Acute kidney injury constitutes a major complication of cardiac surgery in pediatric patients. The present meta-analysis aims to accumulate current literature and assess the efficacy of pharmacological interventions in preventing postoperative renal dysfunction after congenital heart surgery. METHODS: Literature search was conducted using Medline (1966-2018), Scopus (2004-2018), Cochrane Central Register of Controlled Trials CENTRAL (1999-2018), Clinicaltrials...
February 8, 2019: Clinical and Experimental Nephrology
Jeffrey S Isenberg, David D Roberts
Ischemia reperfusion (IR) injury is a process defined by the temporary loss of blood flow and tissue perfusion followed later by restoration of the same. Brief periods of IR can be tolerated with little permanent deficit, but sensitivity varies for different target cells and tissues. Ischemia reperfusion injuries have multiple causes including peripheral vascular disease and surgical interventions that disrupt soft tissue and organ perfusion as occurs in general and reconstructive surgery. Ischemia reperfusion injury is especially prominent in organ transplantation where substantial effort has been focused on protecting the transplanted organ from the consequences of IR...
November 3, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Muralidhar Kanchi, Rudresh Manjunath, Jos Maessen, Lloyd Vincent, Kumar Belani
Background and Aims: Acute kidney injury (AKI) following cardiac surgery is a major complication resulting in increased morbidity, mortality and economic burden. This study was designed to determine the benefit of sodium bicarbonate (NaHCO3 ) supplementation in patients with stable chronic kidney disease (CKD) undergoing off-pump coronary artery bypass grafting (OP-CABG). Material and Methods: We prospectively studied 60 non-dialysis CKD patients with glomerular filtration rate (GFR) ≤60 ml/min/1...
July 2018: Journal of Anaesthesiology, Clinical Pharmacology
David Faraoni, Cornelius Rahe, Karen A Cybulski
Fibrinolytic activation is a major and preventable source of bleeding in neonates and children undergoing cardiac surgery with cardiopulmonary bypass. Based on the existing literature (adult and pediatric; cardiac and noncardiac), prophylactic administration of antifibrinolytic agents can help reduce fibrinolytic activation, and consequently reduces perioperative bleeding and the requirement for blood product transfusion. Due to the increased risk of renal failure and mortality reported in adults undergoing cardiac surgery, aprotinin should not be considered as a safe option in neonates and children...
October 26, 2018: Paediatric Anaesthesia
Shu Wang, Xin Zhang, Bo Xiao, Weiguo Hu, Song Chen, Jianxing Li
OBJECTIVES: To evaluate the efficacy and safety of ultrasound guided percutaneous nephrolithotomy (PCNL) in managing upper urinary tract calculi in patients with spinal deformity based on our experience during the last decade. MATERIALS AND METHODS: A retrospective study was conducted on patients with spinal deformity who were admitted to Beijing Tsinghua Changgung Hospital and the collaborative hospitals from August 2004 to August 2017. Patients diagnosed as urolithiasis and underwent ultrasound guided PCNL performed by the same surgeon were included...
October 25, 2018: BJU International
Young Eun Yoon, Hyung Ho Lee, Joon Chae Na, Woong Kyu Han
OBJECTIVES: To evaluate the clinical implications of postoperative urinary neutrophil gelatinase-associated lipoprotein (NGAL) changes and the association between urinary NGAL (uNGAL) and renal function in living kidney donors. SUBJECTS, PATIENTS AND METHODS: We included 76 healthy adults who underwent donor nephrectomy between December 2013 and November 2014. Perioperative serum creatinine (sCr), uNGAL, serum NGAL (sNGAL), and urinary microalbumin were prospectively measured until 6 months postoperatively...
October 22, 2018: BJU International
Aino Ollila, Leena Vikatmaa, Reijo Sund, Ville Pettilä, Erika Wilkman
Haemodynamic instability predisposes patients to cardiac complications in non-cardiac surgery. Esmolol, a short-acting cardioselective beta-adrenergic blocker might be efficient in perioperative cardiac protection, but could affect other vital organs, such as the kidneys, and post-discharge survival. We performed a systematic review on the use of esmolol for perioperative cardiac protection. We searched PubMed, Ovid Medline and Cochrane Central Register for Controlled trials. Eligible randomized controlled studies (RCTs) reported a perioperative esmolol intervention with at least one of the primary (major cardiac or renal complications during the first 30 postoperative days) or secondary (postoperative adverse effects and all-cause mortality) outcomes...
November 26, 2018: Annals of Medicine
Justin D Lee, Eric J Kuo, Lin Du, Michael W Yeh, Masha J Livhits
BACKGROUND: Patients with renal hyperparathyroidism (RHPT) are susceptible to major electrolyte fluctuations following parathyroidectomy, which may predispose them to early readmission. The purpose of this study is to evaluate risk factors for readmission in patients undergoing parathyroidectomy for RHPT. METHODS: Patients with renal failure who underwent parathyroidectomy were abstracted from the California Office of Statewide Health Planning and Development (1999-2012)...
October 19, 2018: World Journal of Surgery
Sumin Yang, Changhun Lee, Bong-Seon Lee, Eui Kyun Park, Kyung-Min Kim, Jong-Sup Bae
BACKGROUND: Aspalathin (Aspt) and nothofagin (Not) were reported to have antioxidant activity and are the two major active dihydrochalcones in green rooibos. This study was conducted to determine whether Asp and Not can modulate renal functional damage in a mouse model of sepsis and to elucidate the underlying mechanisms. METHODS: The potential of Aspt and Not treatment to reduce renal damage induced by cecal ligation and puncture (CLP) surgery in mice was measured by assessing blood urea nitrogen (BUN), serum creatinine, total urine protein, levels of lactate dehydrogenase (LDH), nitric oxide (NO), tumour necrosis factor (TNF)-α, interleukin (IL)-6, and myeloperoxidase (MPO), lipid peroxidation, total glutathione, glutathione peroxidase activity, catalase activity, and superoxide dismutase activity...
July 27, 2018: Pharmacological Reports: PR
Emmanuel Canet, Rinaldo Bellomo
PURPOSE OF REVIEW: The present article reviews the recent literature on the main aspects of perioperative acute kidney injury (AKI). RECENT FINDINGS: AKI occurs in 1 in every 10 surgical patients, with cardiac, orthopedic, and major abdominal surgeries being the procedures associated with the highest risk. Overall, complex operations, bleeding, and hemodynamic instability are the most consistent procedure-related risk factors for AKI. AKI increases hospital stay, mortality, and chronic kidney disease, gradually with severity...
December 2018: Current Opinion in Critical Care
Maxime Rossi, Sandrine Delbauve, Eric Wespes, Thierry Roumeguère, Oberdan Leo, Véronique Flamand, Alain Le Moine, Jean-Michel Hougardy
Acute kidney injury (AKI) is a major public health concern, which is contributing to serious hospital complications, chronic kidney disease (CKD) and even death. Renal ischemia-reperfusion injury (IRI) remains a leading cause of AKI. The stress-responsive enzyme, heme oxygenase-1 (HO-1) mediates protection against renal IRI and may be preventively induced using hemin prior to renal insult. This HO-1 induction pathway called hemin preconditioning is largely known to be effective. Therefore, HO-1 might be an interesting therapeutic target in case of predictable AKI (e...
September 18, 2018: Biochemical and Biophysical Research Communications
Jessica M Mayor, Wilmer Valentin, Sherene Sharath, Neal R Barshes, Jayer Chung, Panos Kougias, Joseph L Mills
BACKGROUND: Despite advances in endovascular therapy, infrainguinal bypass continues to play a major role in achieving limb salvage. In this study, we sought to compare outcomes of infrainguinal bypass in patients with limb-threatening ischemia who presented with or without foot infection. METHODS: We conducted a retrospective cohort study of patients who underwent infrainguinal bypass for chronic limb-threatening ischemia at a single institution. End points of interest included long-term mortality, 45-day readmission, postoperative length of stay (LOS), major amputation, and time to wound healing...
July 28, 2018: Journal of Vascular Surgery
Florian Brettner, Daniel Chappell, Tim Nebelsiek, Daniela Hauer, Gustav Schelling, Bernhard F Becker, Markus Rehm, Florian Weis
BACKGROUND: Patients undergoing cardiac surgery commonly develop systemic inflammation associated with tissue edema, which impairs outcome. One main pathomechanism leading to the edema is the deterioration of the endothelial glycocalyx, a key component of the vascular barrier. In animal models hydrocortisone has proved to be protective for the glycocalyx. OBJECTIVE: This trial evaluates the effect of hydrocortisone on glycocalyx integrity in patients undergoing cardiac surgery with cardiopulmonary bypass...
May 19, 2018: Clinical Hemorheology and Microcirculation
A Shulman, M Peltonen, C D Sjöström, J C Andersson-Assarsson, M Taube, K Sjöholm, C W le Roux, L M S Carlsson, P-A Svensson
BACKGROUND: Obesity is a major public health problem leading to co-morbidities such as diabetes, hypertension and kidney failure. Bariatric surgery results in pronounced and maintained weight loss and prevention of obesity-related diseases and their complications. Most studies of bariatric surgery on kidney disease show improvements after surgery. However, long-term studies analyzing hard end-points are lacking. Here we report on the long-term effects of bariatric surgery compared to usual obesity care on incidence of end-stage renal disease (ESRD) alone and in combination with chronic kidney disease stage 4 (CKD4/ESRD)...
June 2018: International Journal of Obesity: Journal of the International Association for the Study of Obesity
Guang-Dao Chen, Jun-Liang Zhang, Yi-Ting Chen, Ju-Xing Zhang, Tao Wang, Qi-Yi Zeng
The aim of the present study was to explore the effects and mechanisms of insulin on mitochondrial oxidative stress in septic acute kidney injury (AKI). Male Sprague Dawley rats were divided randomly into four groups: Control group, sham surgery group, cecal ligation and puncture (CLP) group, and CLP plus insulin group. Blood specimens and kidney tissues were obtained at 12 and 24 h after surgery as separate experiments. Analyses of histology and indicators of renal injury [blood urea nitrogen (BUN) and serum creatinine (CRE) and neutrophil gelatinase-associated lipocalin (NGAL)], mitochondrial function [adenosine triphosphate (ATP) and mitochondrial membrane potential (MMP)], oxidative stress [inducible nitric oxide synthase (iNOS), reactive oxygen species (ROS) and nitric oxide (NO)], endogenous antioxidant systems [superoxide dismutase (SOD) and glutathione (GSH)] as well as the expression of uncoupling protein (UCP), PINK1 protein (a major mediator of mitophagy), PGC1α protein (a major regulator of mitochondrial biogenesis) were performed...
April 2018: Experimental and Therapeutic Medicine
Sheriff D Akinleye, Garret Garofolo, Maya Deza Culbertson, Peter Homel, Orry Erez
Introduction: Obesity is an oft-cited cause of surgical morbidity and many institutions require extensive supplementary screening for obese patients prior to surgical intervention. However, in the elderly patients, obesity has been described as a protective factor. This article set out to examine the effect of body mass index (BMI) on outcomes and morbidity after hip fracture surgery. Methods: The National Surgical Quality Improvement Program database was queried for all patients undergoing 1 of 4 surgical procedures to manage hip fracture between 2008 and 2012...
2018: Geriatric Orthopaedic Surgery & Rehabilitation
Joana B Neves, John Withington, Sarah Fowler, Prasad Patki, Ravi Barod, Faiz Mumtaz, Tim O'Brien, Michael Aitchison, Axel Bex, Maxine G B Tran
OBJECTIVE: To report on the contemporary UK experience of surgical management of renal oncocytomas. PATIENTS AND METHODS: Descriptive analysis of practice and postoperative outcomes of patients with a final histological diagnosis of oncocytoma included in The British Association of Urological Surgeons (BAUS) nephrectomy registry from 01/01/2013 to 31/12/2016. Short-term outcomes were assessed over a follow-up of 60 days. RESULTS: Over 4 years, 32 130 renal surgical cases were recorded in the UK, of which 1202 were oncocytomas (3...
June 2018: BJU International
Teng C Lee, Zachary Kon, Faisal H Cheema, Maria V Grau-Sepulveda, Brian Englum, Sunghee Kim, Paramita S Chaudhuri, Vinod H Thourani, Gorav Ailawadi, G Chad Hughes, Matthew L Williams, J Matthew Brennan, Lars Svensson, James S Gammie
PURPOSE: Management of acute type A aortic dissection (AAAD) is challenging and operative strategies are varied. We used the STS Adult Cardiac Surgery Database (STS ACSD) to describe contemporary surgical strategies and outcomes for AAAD. METHODS: Between July 2011 and September 2012, 2982 patients with AAAD underwent operations at 640 centers in North America. RESULTS: In this cohort, median age was 60 years old, 66% were male, and 80% had hypertension...
January 2018: Journal of Cardiac Surgery
Jianrao Lu, Yang Yi, Ronghua Pan, Chuanfu Zhang, Haiyan Han, Jie Chen, Wenrui Liu
Renal ischemia reperfusion injury (RIRI) refers to the irreversible damage for renal function when blood perfusion is recovered after ischemia for an extended period, which is common in clinical surgeries and has been regarded as a major risk for acute renal failures (ARF) that is accompanied with unimaginably high morbidity and mortality. Hypoxia during ischemia followed by reoxygenation via reperfusion serves as a major event contributing to cell apoptosis, which has been widely accepted as the vital pathogenesis in RIRI...
March 2018: Journal of Natural Medicines
Negar Motayagheni, Sheshanna Phan, Crystal Eshraghi, Ala Nozari, Anthony Atala
BACKGROUND: Renal protection is a critical concept for anesthesiologists, nephrologists, and urologists, since anesthesia and renal function are highly interconnected and can potentially interfere with one another. Therefore, a comprehensive understanding of anesthetic drugs and their effects on renal function remains fundamental to the success of renal surgeries, especially transplant procedures. Some experimental studies have shown that some anesthetics provide protection against renal ischemia/reperfusion (IR) injury, but there is limited clinical evidence...
2017: American Journal of Nephrology
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