Información de la revista
Vol. 34. Núm. 5.Septiembre 2014
Páginas 545-692
Descargar PDF
Más opciones de artículo
Vol. 34. Núm. 5.Septiembre 2014
Páginas 545-692
DOI: 10.3265/Nefrologia.pre2014.Jul.11953
Acceso a texto completo
Evaluación de fracaso renal agudo subclínico tras cirugía de aneurisma aórtico abdominal utilizando nuevos marcadores: L-FABP y H-FABP
Assessment of subclinical acute kidney injury after abdominal aortic aneurysm surgery using novel markers: L-FABP and H-FABP
Michał Kokota, Grzegorz Biolikb, Damian Ziajab, Tadeusz Fojta, Leszek Kędzierskia, Katarzyna Antoniaka, Mirosława Janowskaa, Krzysztof Pawlickic, Krzysztof Ziajab, Jan Duławaa
a Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, Katowice, Poland,
b Department of General and Vascular Surgery, Medical University of Silesia, Katowice, Poland, Katowice, Poland,
c Department of Biophysics Medical University of Silesia, Katowice, Poland, Katowice, Poland,
Este artículo ha recibido
Información del artículo
Descargar PDF

Antecedentes: Una de las complicaciones más graves de la cirugía reparatoria de aneurisma aórtico abdominal (AAA) es el fracaso renal agudo (FRA). Incluso un pequeño ascenso de creatinina sérica se asocia a un aumento de la mortalidad. El objetivo de este estudio ha sido valorar la dinámica del FRA después de cirugía electiva de AAA utilizando nuevos marcadores. Métodos: En el estudio se incluyeron 22 pacientes con AAA. Medimos la proteína hepática transportadora de ácidos grasos (u-L-FABP) y la proteína cardíaca transportadora de ácidos grasos (u-h-FABP) en orina, antes, durante y dentro de los tres días siguientes a la cirugía. Resultados: Se observó una brusca y significativa elevación de ambas FABP en orina, normalizada a creatinina en orina; el nivel de u-L-FABP alcanzó su pico dos horas después de quitar la abrazadera aórtica {137,79 (38,57-451,79) frente a 9,99 (6,82-12,42) ng/mg del valor basal p < 0,05; los valores son medianos (cuartil inferior-superior)}. El pico de la u-H-FABP se notó 72 horas después de quitar la abrazadera aórtica {16,462 (4,182-37,595) frente a 0,141 (0,014-0,927) ng/mg del valor basal}. El nivel de creatinina sérica no cambió de manera significativa durante el período de estudio. Conclusiones: El aumento significativo de ambas u-L-FABP y u-H-FABP después de cirugía de AAA indica la lesión tubular renal distal y proximal en la población estudiada. Nuestros resultados sugieren que después de una cirugía de AAA el túbulo distal puede ser más afectado que el proximal. Las u-FABP podrían servir como biomarcadores sensitivos de la lesión tubular renal y permitir detectar la fase más precoz de FRA.

Palabras clave:
Proteína hepática transportadora de ácidos grasos
Palabras clave:
Proteína cardíaca transportadora de ácidos grasos
Palabras clave:
Fracaso renal agudo
Palabras clave:
Cirugía de aneurisma aórtico abdominal

Background: One of the most severe complications of repair surgery for abdominal aortic aneurysms (AAA) is acute kidney injury (AKI). Even small rises in serum creatinine are associated with increased mortality. The aim of this study was to assess the dynamics of AKI after elective AAA surgery using novel markers. Methods: The study group consisted of 22 patients with AAA. We measured urinary liver- (u-L-FABP) and heart-type fatty acid-binding proteins (u-H-FABP) before, during and within 3 days after surgery. Results: We found an abrupt and significant elevation of both urine FABPs normalized to urinary creatinine; u-L-FABP reached its peak value 2 hours after aortic clamp release {137.79 (38.57-451.79) vs. 9.94 (6.82-12.42) ng/mg baseline value, p<0.05; values are medians (lower-upper quartile)}. The peak value of u-H-FABP was reported 72 hours after aortic clamp release {16.462 (4.182-37.595) vs. 0.141 (0.014-0.927) ng/mg baseline value, p<0.05}. The serum creatinine level did not changed significantly during the investigation period. Conclusions: The significant rise of both u-L-FABP and u-H-FABP after AAA surgery indicates renal proximal and distal tubule injury in this population. Our results suggest that, after AAA surgery, the distal tubules could be more affected than the proximal ones. u-FABPs could serve as sensitive biomarkers of kidney tubular injury and may allow to detect the very early phases of AKI.

Liver-type fatty acid-binding protein
Heart-type fatty acid-binding protein
Acute kidney injury
Abdominal aortic aneurysm surgery
El Texto completo está disponible en PDF
Hagivara S, Saima S, Negishi K, Takeda R, Miyauchi N, Akiyama Y, et al. High incidence of renal failure in patients with aortic aneurysms. Nephrol Dial Transplant 2007;22:1361-8. [Pubmed]
Martin MC, Giles KA, Pomposelli FB, Hamdan AD, Wyers MC, Schermerhorn ML National outcomes after open repair of abdominal aortic aneurysms with visceral or renal bypass. Ann Vasc Surg 2010;24:106-12. [Pubmed]
Chuasuwan A, Kellum JA. Acute kidney injury and its management. Contrib Nephrol 2011;171:218-25. [Pubmed]
Thakar CV, Worley S, Arrigain S, Yared JP, Paganini EP. Influence of renal dysfunction on mortality after cardiac surgery: modyfying effect of preoperative renal function. Kidney Int 2005;67:1112-9. [Pubmed]
Lattanzio MR, Kopyt NP. Acute kidney injury: new concepts in definition, diagnosis, pathophysiology, and treatment. J Am Osteopath Assoc 2009;109:13-9. [Pubmed]
Torregrosa I, Montoliu C, Urios A, Elmlili N, Puchades MJ, Sol??s MA, et al. Early biomarkers of acute kidney failure after heart angiography or heart surgery in patients with acute coronary syndrome or acute heart failure. Nefrologia 2012;32:44-52. [Pubmed]
Nickolas TL, Barasch J, Devarajan P. Biomarkers in acute and chronic kidney disease. Curr Opin Nephrol Hypertens 2008;17:127-32. [Pubmed]
Siew ED, Ware LB, Ikizler TA. Biological markers of acute kidney injury. J Am Soc Nephrol 2011;22:810-20. [Pubmed]
Pelsers MM. Fatty acid-binding protein as marker for renal injury. Scand J Clin Lab Invest Suppl 2008;241:73-7. [Pubmed]
Thurman JM, Parikh CR. Peeking into the black box: new biomarkers for acute kidney injury. Kidney Int 2008;73:379-81. [Pubmed]
Pelsers MM, Hermens WT, Glatz JF. Fatty acid-binding proteins as plasma markers of tissue injury. Clin Chim Acta 2005;352:15-35. [Pubmed]
Hofstra JM, Deegens JK, Steenbergen EJ, Wetzels JF. Urinary excretion of fatty-binding proteins in idiopathic membranous nephropathy. Nephrol Dial Transplant 2008;23:3160-5. [Pubmed]
G??mez Marcos MA, Rodr??guez S??nchez E, Recio Rodr??guez JI, Mart??n Cantera C, Ramos Blanes R, Garc??a Ortiz L. Differences between the CKD-EPI and the MDRD equations when estimating the glomerular filtration rate in hypertensive patients. Nefrologia 2010;30:458-62. [Pubmed]
Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, Mintz et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol 2004;44:1393-9. [Pubmed]
Kamijo-Ikemori A, Sugaya T, Kimura K. Urinary fatty acid binding protein in renal disease. Clin Chim Acta 2006;374:1-7. [Pubmed]
Veerkamp JH, Peeters RA, Maatman RG. Structural and functional features of different types of cytoplasmic fatty acid-binding proteins. Biochim Biophys Acta 1991;1081:1-24. [Pubmed]
Wang G, Gong Y, Anderson J, Sun D, Minuk G, Roberts MS, et al. Antioxidative function of L-FABP in L-FABP stably transfected Chang liver cells. Hepatology 2005;42:871-9.
Wolfrum C, Borrmann CM, Borchers T, Spener F. Fatty acids and hypolipidemic drugs regulate peroxisome proliferator-activated receptors alpha- and gamma-mediated gene expression via liver fatty acid binding protein: a signaling path to the nucleus. Proc Natl Acad Sci U S A 2001;98:2323-8. [Pubmed]
Ferguson MA, Vaidya VS, Waikar SS, Collings FB, Sunderland KE, Gioules CJ, et al. Urinary liver-type fatty acid-binding protein predicts adverse outcomes in acute kidney injury. Kidney Int 2010;77:708-14. [Pubmed]
Portilla D, Dent C, Sugaya T, Nagothu KK, Kundi I, Moore P, et al. Liver fatty acid-binding protein as a biomarker of acute kidney injury after cardiac surgery. Kidney Int 2008;73:465-72. [Pubmed]
Nakamura T, Sugaya T, Node K, Ueda Y, Koide H. Urinary excretion of liver-type fatty acid-binding protein in contrast medium-induced nephropathy. Am J Kidney Dis 2006;47:439-44. [Pubmed]
Bachorzewska-Gajewska H, Poniatowski B, Dobrzycki S. NGAL (neutrophil gelatinase-associated lipocalin) and L-FABP after percutaneous coronary interventions due to unstable angina in patients with normal serum creatinine. Adv Med Sci 2009;54:221-4. [Pubmed]
Yamamoto T, Noiri E, Ono Y, Doi K, Negishi K, Kamijo A, et al. Renal L-type fatty acid-binding protein in acute ischemic injury. J Am Soc Nephrol 2007;18:2894-902. [Pubmed]
Pelsers MM, Hermens WT, Glatz JF. Fatty acid-binding proteins as plasma markers of tissue injury. Clin Chim Acta 2005;352:15-35. [Pubmed]
Choroma??ska B, My??liwiec P, Dadan J, Hady RH, Chabrowski A. The clinical significance of fatty acid binding proteins. Postepy Hig Med Dosw (Online) 2011;65:759-63.
Storch J, Thumser AE. The fatty acid transport function of fatty acid-binding proteins. Biochim Biophys Acta 2000;1486:28-44. [Pubmed]
Maatman RG, Van Kuppevelt TH, Veerkamp JH. Two types of fatty acid-binding protein in human kidney. Isolation, characterization and localization. Biochem J 1991;273:759-66.
Noiri E, Doi K, Negishi K, Tanaka T, Hamasaki Y, Fujita T, et al. Urinary fatty acid-binding protein 1: an early predictive biomarker of kidney injury. Am J Physiol Renal Physiol 2009;296:F669-79. [Pubmed]
Kokot M, Biolik G, Ziaja D, Fojt T, Cisak K, Antoniak K, et al. Acute kidney injury after abdominal aortic aneurysm surgery: detailed assessment of early effects using novelmarkers. Pol Arch Med Wewn 2012;122:353-60. [Pubmed]
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al.; Acute Kidney Injury Network. Acute Kidney Injury Network (AKIN): report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31.
Englberger L, Suri RM, Li Z, Casey ET, Daly RC, Dearani JA, et al. Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for acute kidney injury in patients undergoing cardiac surgery. Crit Care 2011;15:R16. [Pubmed]
Himmelfarb J, Ikizler TA. Acute kidney injury: changing lexicography, definitions, and epidemiology. Kidney Int 2007;71:971-6. [Pubmed]
Huang Y, Don-Wauchope AC. The clinical utility of kidney injury molecule 1 in the prediction, diagnosis and prognosis of acute kidney injury: a systematic review. Inflamm Allergy Drug Targets 2011;10:260-71. [Pubmed]
D??Amico G, Ferrario F, Rastaldi MP. Tubulointerstitial damage in glomerular diseases: its role in the progression of renal damage. Am J Kidney Dis 1995;26:124-32. [Pubmed]
Remuzzi G, Bertani T. Pathophysiology of progressive nepropathies. N Engl J Med 1998;339:1448-56. [Pubmed]
36 Ohta S, Ishimatsu T, Minami J, Ono H, Matsuoka H. Effects of intravascular contrast media on urinary excretion of liver fatty acid-binding protein. Nihon Jinzo Gakkai Shi 2005;47:437-44. [Pubmed]
Negishi K, Noiri E, Doi K, Maeda-Mamiya R, Sugaya T, Portilla D, et al. Monitoring of urinary L-type fatty acid-binding protein predicts histological severity of acute kidney injury. Am J Pathol 2009;174:1154-9. [Pubmed]

Suscríbase a la newsletter

Opciones de artículo
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.