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COMMENTARY
Year : 2015  |  Volume : 9  |  Issue : 4  |  Page : 168-169

Neutrophil-gelatinase associated lipocalin (N-GAL) to assess perioperative acute kidney injury in hand-assisted laparoscopic donor nephrectomy: A pilot study


Department of Renal Surgery, Western Infirmary, Dumbarton Road, Glasgow, United Kingdom

Correspondence Address:
Emma Aitken
Department of Renal Surgery, Western Infirmary, Dumbarton Road, Glasgow
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.1016/j.ijt.2015.10.013

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Introduction: The aim of this study was to evaluate donor acute kidney injury (AKI) using a novel biomarker (NGAL). Methodology: A pilot study of 20 patients undergoing hand-assisted live donor nephrectomy was undertaken. eGFR and serum NGAL measurements were obtained pre-operatively, immediately post-operatively, day 1 and 6 weeks post-operatively. Results: Mean age: 40.6 ± 11.1 years. Mean pre-operative eGFR: 105.6 ± 10.1 ml/min/1.73 m2. Mean day 1 post-op eGFR: 65.7 ± 10.4 ml/min/1.73 m2 (37.7 ± 9.2% reduction from baseline). Mean eGFR 6 weeks post-operatively was 74.1 ± 8.6 ml/min/1.73 m2 (29.4 ± 8.8% reduction from baseline). Serum NGAL increased by 34.1 ± 16.7% following an overnight fast pre-operatively (day 0) (ΔNGAL 45.1 ± 36.0 ng/ml), by a further 14.9 ± 7.2% following surgery (post-op) and a further 3.1 ± 1.2% by post-operative day 1. The largest ΔNGAL was observed during the pre-operative fasting period. ΔNGAL [day −1 to day 0] and [day −1 to post-op] were found to correlate inversely with eGFR at 6 weeks (p < 0.05, r2 = 0.47 and p < 0.001, r2 = 0.52, respectively). Conclusion: Significant AKI occurs with live donor nephrectomy. This is difficult to quantify using standard biochemistry due to the overwhelming effect of nephrectomy on eGFR. AKI is associated with poorer donor eGFR at 6 weeks. Pre-operative hypovolaemia plays a role in AKI. Optimisation of perioperative fluid management is likely to have a protective role.


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