Caractéristiques métabolomiques et expression des biomarqueurs urinaires des patients développant une insuffisance rénale aiguë post circulation extracorporelle

Abstract : Objective: acute kidney injury (AKI) is a major complication after cardiac surgery with cardiopulmonary bypass (CBP). Predictive biomarkers of AKI do not appear specific after CBP. An Analysis of the variation of urinary metabolomics changes could thus be a rapid diagnostic approach to AKI. The objective is to analyze urinary metabolomics variation and urinary biomarkers variations of patients developing AKI after CBP and to verify the risk factors for AKI. Material and methods: all scheduled patients undergoing cardiac surgery under CBP between 17/02/17 and 26/04/17 were included. The main exclusion criterion was a preoperative glomerular filtration rate of less than 30ml / min / 1.73m2. Urinary samples were taken before, after and 1 day after CBP. AKI was determined according to the KDIGO classification. The urinary metabolites changes were analyzed by magnetic resonance spectrometry. Urinary NGAL and angiogenin were assayed by ELISA test. Results: 42 patients were included, 28% developed an AKI. Traditional post-CBP AKI risk factors, including the level of MAP per CBP, were not found. Patients who modified their urine metabolites during CBP developed AKI (46% of AKI in patients not modifying their urinary metabolites compared to 10% in the rest of the cohort, p = 0.02). Urinary NGAL did not vary during the CBP (p=0.6). Urinary angiogenin did vary during the CBP (p=0.001). Conclusions: a change in urinary metabolomics, indicating renal adaptation, characterized patients whose renal function did not deteriorate after CBP. Neither the per-CBP MAP level nor the NGAL post CBP values were associated with the occurrence of an AKI.
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Master Thesis
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Baptiste Fohlen. Caractéristiques métabolomiques et expression des biomarqueurs urinaires des patients développant une insuffisance rénale aiguë post circulation extracorporelle. Médecine humaine et pathologie. 2018. ⟨dumas-02051954⟩

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