Perm Medical JournalPerm Medical JournalПермский медицинский журнал (сетевое издание "Perm medical journal")0136-14492687-1408Eco-Vector7026110.17816/pmj38593-105Literature reviewОбзор литературыReview ArticleCardiac surgery-associated acute kidney injuryКардиохирургически-ассоциированное острое повреждение почекhttps://orcid.org/0000-0003-0141-8719KostyaminYuri D.КостяминЮрий Дмитриевич
Ukraine

Candidate of Medical Sciences, Head of Department of Cardiovascular Surgery

кандидат медицинских наук, заведующий кафедрой сердечно-сосудистой хирургии

kostiamin@mail.ruhttps://orcid.org/0000-0002-6140-5760GrekovIlya S.ГрековИлья Сергеевич
Ukraine

sixth-year student

студент VI курса

ilya.grekov.1998@gmail.comM. Gorky Donetsk National Medical UniversityДонецкий национальный медицинский университет им. М. Горького150920213859310505052021Copyright ©; 2021, Kostyamin Y.D., Grekov I.S.Copyright ©; 2021, Костямин Ю.Д., Греков И.С.2021Kostyamin Y.D., Grekov I.S.Костямин Ю.Д., Греков И.С.http://creativecommons.org/licenses/by-sa/4.0https://permmedjournal.ru/PMJ/article/view/70261

This literature review is devoted to one of the topical multidisciplinary problems of modern clinical practice – the development of acute kidney injury after cardiac surgery. The prevalence of this pathology varies on average from 5 to 43 %, while the frequency of early hospital mortality increases significantly in the population of such patients compared with patients without cardiac surgery-associated renal damage. It is assumed that the work of the artificial circulatory system contributes to the development of such complications, but as shown by many studies, the etiology of such kidney damage is multifactorial and cannot be explained by only one pathogenetic mechanism. The article highlights the current understanding of the etiology, pathogenesis and risk factors of acute kidney injury after cardiovascular interventions, describes new markers of early detection of renal dysfunction, and describes some prognostic aspects of the disease. Early identification and stratification of risk groups will allow for a timely preventive strategy, which will significantly improve early and long-term postoperative outcomes in such patients.

Данный литературный обзор посвящен одной из актуальных мультидисциплинарных проблем современной клинической практики – развитию острого повреждения почек после кардиохирургических вмешательств. Распространенность этой патологии варьируется в среднем от 5 до 43 %, при этом частота ранней госпитальной смертности значительно возрастает в популяции таких пациентов, по сравнению с больными без кардиохирургически-ассоциированного почечного повреждения. Предполагается, что именно работа аппарата искусственного кровообращения способствует развитию подобных осложнений, однако, как показывают данные многих исследований, этиология такого повреждения почек многофакторна и не может быть объяснена лишь одним патогенетическим механизмом. В статье освещены современные представления об этиологии, патогенезе и факторах риска острого повреждения почек после сердечно-сосудистых вмешательств, описаны новые маркеры раннего выявления почечной дисфункции, а также проанализированы некоторые прогностические аспекты заболевания. Раннее выявление и стратификация групп риска позволят проводить своевременную превентивную стратегию в отношении пациентов, что значительно улучшит ранние и отдаленные послеоперационные исходы у таких больных.

acute kidney injurycardiac surgerycardiopulmonary bypassglomer-ular filtration ratekidneysострое повреждение почеккардиохирургияаппарат искусственного кровообращенияскорость клубочковой фильтрациипочкиYuan S.M. Acute kidney injury after pediatric cardiac surgery. Pediatr Neonatol 2019; 60: 3–11.Wang Y., Bellomo R. Cardiac surgery-associated acute kidney injury: Risk factors, pathophysiology and treatment. Nature Reviews Nephrology 2017; 13: 697–711.Smirnov A.V., Rumjancev A.Sh. Ostroe povrezhdenie pochek. Chast' I. Nefrologija 2020; 24: 67–95.Смирнов А.В., Румянцев А.Ш. Острое повреждение почек. Часть I. Нефрология 2020; 24: 67–95.Kellum J.A., Lameire N., Aspelin P., Barsoum R.S., Burdmann E.A., Goldstein S.L. et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kid Int Suppl 2012; 2: 1–138.Kellum J.A., Lameire N., Aspelin P., Barsoum R.S., Burdmann E.A., Goldstein S.L. et al. Kidney disease: improving global outcomes (KDI-GO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kid Int Suppl 2012; 2: 1–138.Jha V., Arici M., Collins A.J. et al. Understanding kidney care needs and implementation strategies in low- and middle-income countries: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Proceedings of the KDIGO Controversies Conference. Kidney international 2016; 1164–1174.Thomas M.E., Blaine C., Dawnay A., Devonald M.A. et al. The definition of acute kidney injury and its use in practice. Kidney Int 2015; 87: 62–73.Kamenshhikov N.O., Podoksenov Ju.K., D'jakova M.L., Bojko A.M., Kozlov B.N. Ostroe povrezhdenie pochek v kardiohirurgii: opredelenie, jepidemiologija, ishody i social'no-jekonomicheskaja znachimost'. Patologija krovoobrashhenija i kardiohirurgija 2020; 24: 11–21 (in Russian).Каменщиков Н.О., Подоксенов Ю.К., Дьякова М.Л., Бойко А.М., Козлов Б.Н. Острое повреждение почек в кардиохирургии: определение, эпидемиология, исходы и социально-экономическая значимость. Патология кровообращения и кардиохирургия 2020; 24: 11–21.Englberger L., Suri R.M., Li Z., Casey E.T., Daly R.C., Dearani J.A., Schaff H.V. Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for acute kidney injury in patients undergoing cardiac surgery. Crit Care 2011; 1: 110–115.Parolari A., Pesce L.L., Pacini D., Mazzanti V., Salis S., Sciacovelli C., Rossi F., Alamanni F. Outcomes MRGoCS. Risk factors for perioperative acute kidney injury after adult cardiac surgery: role of perioperative management. The Annals of thoracic surgery 2012; 93: 584–591.Chew S.T., Hwang N.C. Acute kidney injury after cardiac surgery: a narrative review of the literature. Journal of Cardiothoracic and Vascular Anesthesia 2019; 33: 1122–1138.Ostermann M. Diagnosis of acute kidney injury. Current Opinion in Critical Care 2014; 20: 581–587.Haase-Fielitz A., Haase M., Bellomo R., Calzavacca P., Spura A., Baraki H. et al. Perioperative hemodynamic instability and fluid over-load are associated with increasing acute kidney injury severity and worse outcome after cardiac surgery. Blood Purif 2017; 43: 298–308.Lamy A., Devereaux P.J., Prabhakaran D. et al. Coronary Investigators Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med 2012; 366: 1489–1497.Harling L., Punjabi P.P., Athanasiou T. Miniaturized extracorporeal circulation versus Off-pump coronary artery bypass grafting: what the evidence shows? Perfusion 2011; 26: 40-47.Harling L., Punjabi P.P., Athanasiou T. Miniaturized extracorporeal circulation versus Off-pump coronary artery bypass grafting: what the evidence shows? Perfusion 2011; 26: 40–47.Chen K.P., Cavender S., Lee J., Feng M., Mark R.G., Celi L.A., Mukamal K.J., Danziger J. Peripheral edema, central venous pressure, and risk of AKI in critical illness. Clin J Am Soc Nephrol 2016; 11: 602–608.Wu B., Sun J., Liu S. et al. Relationship among mortality of patients with acute kidney injury after cardiac surgery, fluid balance and ultrafiltration of renal replacement therapy: an observational study. Blood Purif 2017; 44: 32–39.Jiang W., Teng J., Xu J. et al. Dynamic Predictive Scores for Cardiac Surgery–Associated Acute Kidney Injury. Journal of the American Heart Association 2016; 1: 120–122.Sampaio M.C., Maximo C.A., Montenegro C.M., Mota D.M., Fernandes T.R., Bian-co A.C., Amodeo C., Cordeiro A.C. Comparison of diagnostic criteria for acute kidney injury in cardiac surgery. Arq Bras Cardiol 2013; 101: 18–25.Sampaio M.C., Maximo C.A., Montenegro C.M., Mota D.M., Fernandes T.R., Bianco A.C., Amodeo C., Cordeiro A.C. Comparison of diagnostic criteria for acute kidney injury in cardiac surgery. Arq Bras Cardiol 2013; 101: 18–25.Meersch M., Zarbock A. Prevention of cardiac surgery-associated acute kidney injury. Current Opinion in Anaesthesiology 2017; 30: 76–83.Parikh C.R., Mansour S.G. Perspective on clinical application of biomarkers in AKI. Journal of the American Society of Nephrology 2017; 28: 1677–1685.Shang W., Wang Z. The update of NGAL in acute kidney injury. Current Protein & Peptide Science 2017; 18: 1211–1217.Zhou F., Luo Q., Wang L., Han L. Diagnostic value of neutrophil gelatinase-associated lipocalin for early diagnosis of cardiac surgery-associated acute kidney injury: A meta-analysis. European Journal of Cardio-Thoracic Surgery 2016; 49: 746–755.Albert C., Albert A., Kube J. et al. Urinary biomarkers may provide prognostic information for subclinical acute kidney injury after cardiac surgery. The Journal of Thoracic and Cardiovascular Surgery 2018; 155: 2441–2452.McIlroy D.R., Farkas D., Pan K., Pickering J.W., Lee H.T. Combining novel renal injury markers with delta serum creatinine early after cardiac surgery and risk-stratification for serious adverse outcomes: an exploratory analysis. Journal of Cardiothoracic and Vascular Anesthesia 2018; 32: 2190–2200.Xu J., Jiang W., Fang Y., Teng J., Ding X. Management of cardiac sur-gery-associated acute kidney injury. Contrib Nephrol 2016; 187: 131–142.Xu J., Jiang W., Fang Y., Teng J., Ding X. Management of cardiac surgery‐associated acute kidney injury. Contrib Nephrol 2016; 187: 131–142.