Elements of urine sediment and interleukin-18 in acute kidney injury after cardiac surgery
North-Western State Medical University named after I.I. Mechnikov
Changes in the composition of urine sediment and concentration of interleukin-18 (IL-18) in urine were studied 2, 4 and 24 hours after various cardiosurgical interventions in 111 patients divided into 2 groups, taking into account EuroSCORE II scale. In patients of the 1-st group with acute kidney injury (AKI) and glomerular filtration rate (GFR) > 85 ml/min, maximum concentration increase in comparison with initial level (before surgery) was detected 2 hours after surgery for IL-18, through 4 hours for hyaline casts and 24 hours for renal tubular epithelial cells. In urine of patients in this group without AKI, concentration of IL-18, hyaline casts and renal tubular epithelial cells at same time of observation was significantly lower than in patients with AKI.
In patients of 2-nd group (GFR 50 - 85 ml/min) with AKI and without AKI, there were no differences in IL-18 concentration in urine at 2, 4 and 24 hours after cardiac surgery. In patients of 2-nd group with AKI maximum increase in concentration of hyaline casts was detected after 4 hours, and cells of renal epithelium 24 hours after cardiac surgery, and their concentration was significantly higher than in patients without AKI.
The maximal concentration of IL-18, hyaline casts and cells of renal tubular epithelium patients in 2-nd group with AKI was significantly lower than corresponding values in patients of 1-st group with AKI.
Thus, early informative laboratory markers of AKI after cardiac surgery can be IL-18, renal tubular epithelial cells and hyaline casts only in patients whose glomerular filtration rate is above 85 ml/min.
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