Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/10369
Title: Cardiopulmonary bypass-associated acute kidney injury: a pigment nephropathy?
Authors: Haase, Michael;Haase-Fielitz, Anja;Bagshaw, Sean M;Ronco, Claudio;Bellomo, Rinaldo
Affiliation: Department of Intensive Care, Austin Health, Austin Hospital, Melbourne, Vic., Australia, and Department of Nephrology, Charité University Medicine, Berlin, Germany.
Issue Date: 2007
Citation: Contributions To Nephrology; 156(): 340-53
Abstract: Acute kidney injury (AKI) is a common and serious postoperative complication following exposure to cardiopulmonary bypass (CPB). Several mechanisms have been proposed by which the kidney can be damaged and interventional studies addressing known targets of renal injury have been undertaken in an attempt to prevent or attenuate CPB-associated AKI. However, no definitive strategy appears to protect a broad heterogeneous population of cardiac surgery patients from CPB-associated AKI. Although the association between hemoglobinuria and the development of AKI was recognized many years ago, this idea has not been sufficiently acknowledged in past and current clinical research in the context of cardiac surgery-related AKI. Hemoglobin-induced renal injury may be a major contributor to CPB-associated AKI. Accordingly, we now describe in detail the mechanisms by which hemoglobinuria may induce renal injury and raise the question as to whether CPB-associated AKI may actually be, in a significant part, a form of pigment nephropathy where hemoglobin is the pigment responsible for renal injury. If CPB-associated AKI is a pigment nephropathy, alkalinization of urine with sodium bicarbonate might protect from: (1) tubular cast formation from met-hemoglobin; (2) proximal tubular cell necrosis by reduced endocytotic hemoglobin uptake, and (3) free iron-mediated radical oxygen species production and related injury. Sodium bicarbonate is safe, simple to administer and inexpensive. If part of AKI after CPB is truly secondary to hemoglobin-induced pigment nephropathy, prophylactic sodium bicarbonate infusion might help attenuate it. A trial of such treatment might be a reasonable future investigation in higher risk patients receiving CPB.
Internal ID Number: 17464145
URI: http://ahro.austin.org.au/austinjspui/handle/1/10369
DOI: 10.1159/0000102125
URL: http://www.ncbi.nlm.nih.gov/pubmed/17464145
Type: Journal Article
Subjects: Acute Kidney Injury.economics.etiology.prevention & control
Cardiopulmonary Bypass.adverse effects
Health Care Costs
Hemoglobins.adverse effects
Hemoglobinuria.complications.physiopathology.prevention & control
Humans
Kidney Cortex Necrosis.complications.physiopathology.prevention & control
Reactive Oxygen Species.metabolism
Risk Factors
Sodium Bicarbonate.therapeutic use
Appears in Collections:Journal articles

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