Clinical usefulness of urinary liver-type fatty-acid-binding protein as a perioperative marker of acute kidney injury in patients undergoing endovascular or open-abdominal aortic aneurysm repair

Abstract

PurposeAcute kidney injury (AKI) is common after cardiovascular surgery and is usually diagnosed on the basis of the serum creatinine (SCr) level and urinary output. However, SCr is of low sensitivity in patients with poor renal function. Because urinary liver-type fatty-acid-binding protein (L-FABP) reflects renal tubular injury, we evaluated whether perioperative changes in urinary L-FABP predict AKI in the context of abdominal aortic repair.MethodsStudy participants were 95 patients who underwent endovascular abdominal aortic aneurysm repair (EVAR) and 42 who underwent open repair. We obtained urine samples before surgery, after anesthesia induction, upon stent placement, before aortic cross-clamping (AXC), 1 and 2 h after AXC, at the end of surgery, 4 h after surgery, and on postoperative days (PODs) 1, 2, and 3, for measurement of L-FABP. We obtained serum samples before surgery, immediately after surgery, and on PODs 1, 2, and 3, for measurement of SCr. We also plotted receiver-operating characteristic (ROC) curves to identify cutoff laboratory values for predicting the onset of AKI.ResultsWith EVAR, urinary L-FABP was significantly increased 4 h after the procedure (P = 0.014). With open repair, urinary L-FABP increased significantly to its maximum by 2 h after AXC (P = 0.007). With AKI, SCr significantly increased (P < 0.001, P = 0.001) by POD 2. ROC analysis showed urinary L-FABP to be more sensitive than SCr for early detection of AKI.ConclusionUrinary L-FABP appears to be a sensitive biomarker of AKI in patients undergoing abdominal aortic repair.

Acute kidney injury after open and endovascular elective repair for infrarenal abdominal aortic aneurysms

“…However, a comparison among different studies reporting the incidence of AKI after aortic repair is always affected by a wide heterogeneity in the use of definitions and classifications. 10 There is a lack of 11,12 ; moreover, new markers have been evaluated in aortic surgery, such as urinary cystatin C 8,11 and urinary liver-type fatty acid-binding protein, 7 which both appear to be promising tools, although they are still not completely validated for routine practice.…”

“…These classifications are summarized in Table I. Finally, new urinary markers have been recently identified, 7,8 but their application is not widespread in routine practice yet. In this paper, we aim to evaluate the incidence of AKI according to the ARISe classification in a large series of patients who underwent both OAR and EVAR.…”

Urinary excretion of liver-type fatty acid-binding protein reflects the severity of sepsis

“…Urinary L-FABP can predict the onset of AKI after cardiac surgery [13,49,50], pediatric cardiopulmonary bypass [17], stem cell transplantation [12], and endovascular and open-abdominal aortic aneurysm repair [16] as well as in intensive care unit populations [15]. Additionally, L-FABP can also predict the progression to end-stage renal disease (ESRD), the onset of cardiovascular disease (CVD), or death for patients with AKI [14,51], type 2 diabetes [8,52], or chronic kidney a b Fig.…”

“…L-FABP has been shown to be a useful urinary biomarker for the diagnosis of renal disease in the following clinical conditions: diabetic nephropathy [6][7][8][9], anemia [10], acute kidney injury (AKI) [11][12][13][14][15][16], pediatric AKI [17], contrast medium-induced nephropathy [18,19], IgA nephropathy [20], human immunodeficiency virus (HIV)-associated nephropathy [21,22], and reduced graft function in renal transplantation [23,24]. Numerous AKI cohort studies have reported increased urinary levels of L-FABP in patients with septic shockinduced AKI [25][26][27][28].…”

Acute kidney injury after cardiac surgery: a preventable event?

“…To date, several useful biomarkers have been reported, including urine neutrophil gelatinase-associated lipocalin (NGAL), kidney injury marker 1, N-acetyl-β-d-glucosaminidase (NAG), cystatin C, liver-type fatty acid-binding protein (L-FABP) and interleukin-18 [6,7]. Among these biomarkers, NGAL, NAG, cystatin C and L-FABP are covered by Japan's National Heath Insurance system.…”