Biomarcadores renais de lesão glomerular em pacientes submetidos à anestisia para cirurgia arterial
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Data
2011-06-30
Autores
Silva, Leopoldo Muniz da [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Estudar a função renal de pacientes arteriopatas submetidos a cirurgia vascular, avaliando a concordância entre as estimativas do ritmo de filtração glomerular (RFG) obtidos pela aferição da creatinina e cistatina C plasmática, verificando se diabetes, hipertensão e função renal pré-operatórias apresentam relação com função tubular no pós-operatório e investigando a possível influência da hemodiluição na avaliação da função renal por meio da cistatina C. Trata-se de estudo de coorte, prospectivo, incluindo 144 pacientes consecutivos submetidos à anestesia para cirurgia arterial e distribuídos em 4 grupos, sendo (GDH), diabéticos e hipertensos, (GD), diabéticos, (GH), hipertensos e (GN), sem hipertensão ou diabetes. Foram obtidos urina para dosagens laboratoriais de creatinina urinária (Ucr) (mmol⁄L), fosfatase alcalina (FA) (U⁄L), -glutamiltransferase ( GT) (U⁄L) e sangue para dosagem de albumina (g/dL), globulina (g/dL) uréia (mg/dL), creatinina (mg/dL), cistatina C (mg/L) e aferida a osmolaridade plasmática (mOsm/L) no pré-operatórios (M1) e após 24 horas do término da cirurgia (M2). As estimativas do RFG foram comparadas pelo método de Bland-Altman. Os limites de concordância entre as equações para estimativa do RFG pela creatinina e cistatina C estudadas foram amplos tanto no pré como no pós-operatório e a diferença entre as médias das equações analisadas aumentou no período pós-operatório. Em 76,39 % dos pacientes analisados houve diminuição dos valores de cistatina C no pós-operatório. Houve correlação moderada entre a variação de cistatina C e a variação da osmolaridade plasmática (r=0,41; p<0,0001). No modelo de regressão linear múltipla somente a variação da osmolaridade plasmática esteve implicada na variação da cistatina C. Houve aumento dos valores de GT, GT/Ucr e FA x GT/Ucr em M2 no grupo GN...
The aim of this study was to study the renal function of patients submitted to anaesthesia for arterial surgery, evaluating the agreement between GFR equations by cystatin C and creatinine, checking whether preoperative diabetes, hypertension, and renal function had any relationship with postoperative tubule function, and investigating possible hemodilution influence in cystatin C GFR based equations. Prospective cohort study including 144 patients submitted to anaesthesia for arterial surgery enrolled consecutively and divided into four groups: (GDH), diabetes and hypertension, (GD), diabetes, (GH), hypertension, and (GN), without hypertension or diabetes. Urine was obtained for laboratory analysis of urinary creatinine (Ucr) (mmol⁄L), alkaline phosphatase (AP) (U⁄L), -glutamyltransferase ( GT) (U⁄L), and blood for albumin (g/dL), globulin (g/dL), urea (mg⁄dL), creatinine (mg⁄dL), cystatin C (mg⁄L), and the plasma osmolarity (mOsm/L), before (M1) and 24h after the end of surgery (M2). Bland and Altman analysis was used to assessing agreement between two methods of GFR of measurements. The limits of agreement between creatinine and cystatin C GFR based equations were large and the mean difference in postoperative period was considerably higher than in preoperative period. In 76,39% of the patients analyzed, there was a decrease in the cystatin C value in the postoperative period. There was a moderate correlation between the cystatin C variation and the plasma osmolarity variation (r=0,41; p< 0,0001). In the multiple linear regression model, only the plasma osmolarity variation was implicated in the cystatin C variation. Values of GT, GT/Ucr, and AP x GT/Ucr increased at M2 in GN. Patients without renal function compromise (GFR > 90mL/min/1,73m2) presented increased GT/Ucr and AP x GT/Ucr values at M2 and those with slightly compromised renal function (60-90mL/min/1,73m2)... (Complete abstract click electronic access below)
The aim of this study was to study the renal function of patients submitted to anaesthesia for arterial surgery, evaluating the agreement between GFR equations by cystatin C and creatinine, checking whether preoperative diabetes, hypertension, and renal function had any relationship with postoperative tubule function, and investigating possible hemodilution influence in cystatin C GFR based equations. Prospective cohort study including 144 patients submitted to anaesthesia for arterial surgery enrolled consecutively and divided into four groups: (GDH), diabetes and hypertension, (GD), diabetes, (GH), hypertension, and (GN), without hypertension or diabetes. Urine was obtained for laboratory analysis of urinary creatinine (Ucr) (mmol⁄L), alkaline phosphatase (AP) (U⁄L), -glutamyltransferase ( GT) (U⁄L), and blood for albumin (g/dL), globulin (g/dL), urea (mg⁄dL), creatinine (mg⁄dL), cystatin C (mg⁄L), and the plasma osmolarity (mOsm/L), before (M1) and 24h after the end of surgery (M2). Bland and Altman analysis was used to assessing agreement between two methods of GFR of measurements. The limits of agreement between creatinine and cystatin C GFR based equations were large and the mean difference in postoperative period was considerably higher than in preoperative period. In 76,39% of the patients analyzed, there was a decrease in the cystatin C value in the postoperative period. There was a moderate correlation between the cystatin C variation and the plasma osmolarity variation (r=0,41; p< 0,0001). In the multiple linear regression model, only the plasma osmolarity variation was implicated in the cystatin C variation. Values of GT, GT/Ucr, and AP x GT/Ucr increased at M2 in GN. Patients without renal function compromise (GFR > 90mL/min/1,73m2) presented increased GT/Ucr and AP x GT/Ucr values at M2 and those with slightly compromised renal function (60-90mL/min/1,73m2)... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Anestesiologia, Arterias - Cirurgia, Rins - Fisiopatologia, Injury biomarkers
Como citar
SILVA, Leopoldo Muniz da. Biomarcadores renais de lesão glomerular em pacientes submetidos à anestisia para cirurgia arterial. 2011. 107 f. Tese (doutorado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2011.