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5AOUP, Chirurgia Colo-Rettale, Pisa, ITALY Introduction and Aims: Acute kidney injury (AKI) is an important post operative complication with an incidence ranging from 8% to 16% after complex hepatic surgery. Serum creatinine (sCr) is the most common clinical marker of AKI. Other plasma and urinary markers have been proposed as early markers of AKI and to highlight sub-clinical AKI. Aim of the Study: To determine the effect of complex hepatic surgery on classical and sub-clinical markers of AKI. Methods: Thirty-seven patients (28 males), aged 36-84 years (mean 64.6 years), sCr 0.58-1.53 mg/dl (mean 0.90 mg/dl) underwent elective complex hepatic surgery (hepatocellular carcinoma or liver metastases from other primary cancers). The day before, during the surgery and the following 4 days of Intensive Care Unit (ICU) stay, we determined plasma and/or urinary concentrations of creatinine, cystatin C, ß2-microglobulin (ß2M) , ßtrace protein (ßTP) , Neutrophil Gelatinase Associated Lipocalin (NGAL), Heat Shock Protein 70 (HSP 70), urine albumin, urine gamma-glutamyl-transferase (GGT) and lactate dehydrogenase (LDH). Results: The surgical time ranged 135-1380 minutes (mean 610 min) and the total liver ischemia time was 33-396 minutes (mean 112 min). Five patients (13.5%) developed a

A 71-year-old man presented to the nephrology department for the evaluation of chronic kidney disease, which had developed during the past 20 years. The patient had received a diagnosis of tuberous sclerosis complex, or Bourneville's disease, in his late 20s. The physical examination revealed erythematous papules on the chin, nose, and cheeks consistent with facial angiofibromas (Panel A) and small, fleshy periungual fibromas of the toenails (Panel B). The patient had no history of seizures or developmental delay, and he had no family history of similar cutaneous findings. Tuberous sclerosis complex is an autosomal dominant condition that affects cellular differentiation and proliferation. The condition is characterized by the development of hamartomatous lesions that can affect many organ systems, including the central nervous system, eyes, skin, and kidneys. Facial angiofibromas consist of blood vessels and fibrous tissue. Periungual fibromas are benign tumors that are composed of connective tissue and typically appear in the second decade of life or later. Patients with this condition often have renal involvement, including the formation of angiomyolipomas or extensive renal cysts. For this patient, we recommended low salt intake, tight blood-pressure control (<130/80 mm Hg) with 5 mg of amlodipine twice daily, and avoidance of nonsteroidal antiinflammatory drugs. One year later, he had stable kidney function and unchanged cutaneous findings.