Neutrophil Gelatinase-associated Lipocalin Significantly Correlates with Ischemic Damage in Patients Undergoing Laparoscopic Partial Nephrectomy

Meltem Savran Karadeniz, Isbara Alp Enişte, Hayriye Şentürk Çiftçi, Sebahat Usta, Tzevat Tefik, Öner Şanlı, Kamil Pembeci, Kamil Mehmet Tuğrul, Meltem Savran Karadeniz, Isbara Alp Enişte, Hayriye Şentürk Çiftçi, Sebahat Usta, Tzevat Tefik, Öner Şanlı, Kamil Pembeci, Kamil Mehmet Tuğrul

Abstract

Background: Laparoscopic partial nephrectomy, which minimizes renal function loss due to its nephron sparing nature, has become a standard technique among many experienced centers worldwide for surgical treatment of localized kidney tumors. Although partial nephrectomy will remain the gold standard, we need to improve perioperative management and surgical method to prevent postoperative acute kidney injury.

Aims: To demonstrate the frequency of the development of postoperative acute kidney injury following laparoscopic partial nephrectomy in patients with healthy contralateral kidney and determine the early predictive effects of serum neutrophil gelatinase-associated lipocalin on ischemia-reperfusion injury and its association with warm ischemia time.

Study design: Cross-sectional study.

Methods: Eighty patients were included. We analyzed tumor size, operating time, duration of anesthesia, and warm ischemia time. Serum samples were obtained for measurement of serum creatinine, estimated glomerular filtration rate, and neutrophil gelatinase-associated lipocalin level preoperatively, at the postoperative 2nd hour, and on postoperative days 1 and 2. We used receiver operating characteristic curve for determining the cut-off point of neutrophil gelatinase-associated lipocalin to detect postoperative acute kidney injury. Correlation analysis was performed using Spearman’s test.

Results: Twenty-seven patients developed acute kidney injury on postoperative day 2, and the neutrophil gelatinase-associated lipocalin level increased significantly at the postoperative 2nd hour in the acute kidney injury group (p=0.048). For a cut-off of 129.375 ng/mL neutrophil gelatinase-associated lipocalin, the test showed 70.0% sensitivity and 68.3% specificity for the detection of acute kidney injury at the postoperative 2nd hour. For a cut-off of 184.300 ng/mL neutrophil gelatinase-associated lipocalin, the test exhibited 73.3% sensitivity and 63.3% specificity for the detection of acute kidney injury on postoperative day 1. A significant correlation was found between warm ischemia time and neutrophil gelatinase-associated lipocalin level at the postoperative 2nd hour (r=0.398, p=0.003). The creatinine values were significantly higher and the estimated glomerular filtration rates were significantly lower on postoperative days 1 and 2 in the acute kidney injury group compared with those in the non-acute kidney injury group (p<0.001).

Conclusion: The neutrophil gelatinase-associated lipocalin may be used as an alternative biomarker to serum creatinine in differentiation of ischemic damage in patients undergoing laparoscopic partial nephrectomy.

Keywords: Acute kidney injury; laparoscopic partial nephrectomy; neutrophil gelatinase-associated lipocalin; reperfusion damage.

Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1
Mean arterial pressure (mmHg) follow-up throughout the perioperative period. Data are presented as mean ± standard deviation.
Figure 2
Figure 2
Correlation of warm ischemia time and NGAL levels at postoperative 2nd hour. NGAL: neutrophil gelatinase-associated lipocalin
Figure 3
Figure 3
Correlation of warm ischemia time and NGAL levels at postoperative day 1. NGAL: neutrophil gelatinase-associated lipocalin
Figure 4
Figure 4
ROC curve of NGAL. Sensitivity, specificity, positive and negative predictivity of NGAL levels at postoperative 2nd hour and on postoperative day 1 in patients who developed AKI. NGAL: neutrophil gelatinase-associated lipocalin; ROC: receiver-operating characteristic; AKI: acute kidney injury

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