ISSN : 2146-3123
E-ISSN : 2146-3131

Neutrophil Gelatinase-Associated Lipocalin Significantly Correlates with Ischemic Damage in Patients Undergoing Laparoscopic Partial Nephrectomy
Meltem Savran Karadeniz1, Isbara Alp Enişte2, Hayriye Şentürk Çiftçi3, Sebahat Usta3, Tzevat Tefik4, Öner Şanlı4, Kamil Pembeci1, Kamil Mehmet Tuğrul1
1Department of Anesthesiology, İstanbul University School of Medicine, İstanbul, Turkey
2Clinic of Anesthesiology, Florence Nightingale Hospital, İstanbul, Turkey
3Department of Medical Biology, İstanbul University School of Medicine, İstanbul, Turkey
4Department of Urology, İstanbul University School of Medicine, İstanbul, Turkey
DOI : 10.4274/balkanmedj.2018.0852

Background: Laparoscopic partial nephrectomy, minimizing renal function loss due to its nephron sparing nature, has become a standard technique among many experienced centers worldwide in the 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: We aimed to demonstrate the frequency of the development of postoperative acute kidney injury following laparoscopic partial nephrectomy in patients with healthy contralateral kidney and the early predictive effects of serum neutrophil gelatinase-associated lipocalin in ischemia reperfusion injury and its association with the warm ischemia time. 
Study Design: Cross-sectional study.
Methods: Eighty patients were included in this study. 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 preoperatively, at postoperative 2nd hour, 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 the Spearman’s test. 
Results: 27 patients developed acute kidney injury on postoperative day 2, neutrophil gelatinase-associated lipocalin increased significantly higher at postoperative 2nd hour in acute kidney injury group (p=0.048). For a cut-off of 129.375 ng/ml neutrophil gelatinase-associated lipocalin, the test had 70.0% sensitivity and 68.3% specificity for the detection of at postoperative 2nd hour acute kidney injury. For a cut-off of 184.300 ng/ml neutrophil gelatinase-associated lipocalin, the test had 73.3% sensitivity and 63.3% specificity for the detection of on postoperative day 1 acute kidney injury. There was a significant correlation between warm ischemia time and neutrophil gelatinase-associated lipocalin at postoperative 2nd hour (r = 0.398, p = 0.003). Creatinine values were significantly higher and estimated glomerular filtration rate values were significantly lower on postoperative days 1 and 2 in acute kidney injury group compared to non-acute kidney injury group (p<0.001) 
Conclusion: Receiver operating curve analysis showed that the serum neutrophil gelatinase-associated lipocalin has a valuable diagnostic performance for detecting for AKI. We suggest that 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 : Laparoscopic partial nephrectomy, neutrophil gelatinase-associated lipocalin, acute kidney injury
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