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, Eposter SFAR 2017, vol.9

, Agression rénale aiguë pendant la circulation extracorporelle ? Objectifs: Rechercher une association entre ARA post opératoire et le niveau de PAM per CEC Caractériser les variations du métabolome urinaire des patients développant une ARA

?. Matériel and . Méthodes, Critère d'inclusion: Patients opérés d'une chirurgie cardiaque programmée sous CEC. ? Critères de non inclusion: ? DFG < 30 ml/ min, ? Injection de produit de contraste iodé dans les 24 heures précédant la chirurgie

, Recueil de 3 échantillons urinaires par patient : Pré CEC, post CEC, à J1

, ? Le métabolome de chaque échantillon a été analysé par spectrométrie avec résonnance magnétique nucléaire basée sur les protons

?. Résultats, ? 42 patients inclus, 28% d'ARA selon les critères KDIGO

, 47) ? Pas de différence entre les groupes concernant la durée et la sévérité des épisodes d'hypotension per CEC, p.0

, Nous avons constitué 2 groupes au sein de la cohorte en fonction des variations du métabolome entre le début et la fin de la CEC

, ? Les patients qui modifiaient peu leur métabolome urinaire au cours de la CEC développaient une ARA

, de réponse adaptative cellulaire sont donc ceux qui ont présenté une ARA post opératoire Conclusion : Le développement d'une ARA postopératoire n'était pas associé à la sévérité ni à la durée de l'hypotension per CEC. L'analyse métabolomique urinaire montre une absence de réponse adaptative rénale chez les patients ayant une ARA postopératoire, pp.11-20

, Borne e-communications B1

B. Fohlen, TM.Huynh (1), C.Latremouille (2) , N.Pallet

, Anesthésie réanimation, Chirurgie cardiovasculaire, issue.2

, Les biomarqueurs prédictifs d'ARA ne semblent pas spécifiques après une CEC. L'analyse de la variation du métabolome urinaire pourrait ainsi être une approche diagnostique d'ARA. L'objectif principal de cette étude est de caractériser les variations du métabolome urinaire pendant la CEC. Les objectifs secondaires sont l'évaluation des facteurs de risques d, Caractéristiques métabolomiques et expression des biomarqueurs urinaires des patients développant une insuffisance rénale aiguë post circulation extracorporelle Résumé (français)

. Matériel, Le principal critère de non inclusion était un débit de filtration glomérulaire préopératoire inférieur à 30ml/min/1,73m2. Un échantillon urinaire était prélevé en pré, post CEC et à J1. L'ARA était déterminée selon la classification KDIGO. Le métabolome urinaire était analysé par spectrométrie par résonnance magnétique. NGAL et l'angiogénine urinaire (ANGu) étaient dosés par méthode ELISA. Résultats: 42 patients ont été inclus, 28% ont développé une ARA. Les facteurs de risque traditionnels d'ARA post CEC n'ont pas été retrouvés. Les patients qui modifiaient leur métabolome développaient une ARA, Tous les patients programmés opérés d'une chirurgie

, Conclusion: Les patients développant une ARA post CEC ont une variation moindre du métabolome urinaire. Le NGAL urinaire ne variait pas durant la CEC, Nous n'avons pas retrouvé les facteurs de risque habituels d'ARA

, Mots clés (français) : Agression rénale aigue, circulation extra corporelle, biomarqueurs, hémodynamique, pression artérielle moyenne

. Titre, 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, Metabolomic characteristics and expression of urinary biomarkers in patients developing acute kidney injury after cardiopulmonary bypass Abstract (english) : Objective: Acute kidney injury (AKI) is a major complication after cardiac surgery with cardiopulmonary bypass (CBP)

, 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

. Keywords, Acute kidney injury, cardiopulmonary bypass, biomarkers, hemodynamics, mean arterial pressure, urinary metabolomics

, Université Paris Descartes Faculté de Médecine Paris Descartes 15