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Master Thesis

Intérêt de la mesure des index de résistance rénaux en péri-opératoire de chirurgie aortique

Abstract : Introduction. Postoperative acute kidney injury (AKI) incidence in aortic surgery is 5.5 to 20% (1, 2) and 30% in our unit. Etiology is multifactorial. Renal biomarkers available still have a limited interest with delayed kinetics. Earlier detection of AKI could enable practitioners to improve the prognosis of these patients. Renal resistive index (RRI) measurement seems to present an interest in cardiac surgery (3) .The aim of this study was to show the relevance of this marker during perioperative aortic surgery (aortic prosthesis by open or endovascular surgery). Methods. This prospective, observational study included all patients treated in our vascular surgery department of University Hospital of Bordeaux, after obtaining their informed consent. A renal Doppler was performed the day before surgery (D-1), in post-anesthesia care (D0) and on day 1 (D1). A daily biological monitoring of renal function (creatinine, urea) and an assay of plasma NGAL on day 0 (D0) were realized. We compared RRI in two groups of patients according to the presence of AKI at day 5 postoperatively (KDIGO score > 1 (4)). Results. From December 2013 to July 2014, 111 patients were included (70 endovascular aortic surgery and 41 by open surgery). The overall mortality was 8.1% (9/111). Incidence of KDIGO score > 1 was 9.9 % (11/111). The mortality of KDIGO > 1 patients was 45.4% (5/11). Between the two groups, we found significant differences in plasmatic N-Gal values (349 ± 253 AKI vs 166 ± 126 non AKI, p= 0.002), D-1 RRI (0.706 ± 0.104 AKI vs 0.65 ± 0.061 non AKI, p= 0.0173) , D0 RRI (0.745 ± 0.123 AKI vs 0.658 ± 0.061 non AKI, p = 0.001) and D1 RRI (0.75 ± 0.139 AKI vs 0.669 ± 0.63 non AKI, p = 0.0013) respectively. Discussion. This study confirms the interest of RRI measurement in perioperative aortic surgery period. This simple and non-invasive tool could allow to identify patients at risk of postoperative renal failure. In addition, high post-surgery indexes may alert clinicians about the unfavorable evolution of renal function.
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Master Thesis
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Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Wednesday, December 16, 2015 - 5:58:10 PM
Last modification on : Wednesday, August 23, 2017 - 4:30:56 PM
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Arnaud Élicagaray. Intérêt de la mesure des index de résistance rénaux en péri-opératoire de chirurgie aortique. Médecine humaine et pathologie. 2015. ⟨dumas-01245147⟩

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