Cardiac Surgery and Ischaemia/Reperfusion

Summary

Urinary GST levels during surgery predict increased post operative serum creatinine levels.
Urinary GST levels can demonstrate the effects of different therapeutic options.
Urinary GSTs can be used to study the renal effects of anaesthetics and other pharmaceuticals.

Selected Articles

Human Studies

1) Alpha glutathione S-transferase and pi glutathione S-transferase are novel biomarkers of acute kidney injury following adult cardiac surgery.
Koyner, J.L., Schuster, K., Trevino, S. and Murray, PT. (2009). Poster presented at the World Congress of Nephrology, Milan, May 22-26, 2009.

76 consecutive subjects undergoing cardiac surgery studied.
Increases in intra-operative, and immediately post-operative, urinary GST levels were associated with post-operative increases in serum creatinine.
Increases in πGST were associated with more severe renal injury (AKI grade III).

2) Comparison of Novel Early Biomarkers of Acute Kidney Injury (AKI) to predict the Course and Severity of AKI Developing after Cardiac Surgery

JL Koyner MD, P Devarajan MD, VS Vaidya PhD, and Murray, PT. (2009). Poster presented at the World American Society of Nephrology, San Diego, October 2009

Evaluating the utility of urinary biomarkers Cystatin C (CyC), Neutrophil Gelatinase Associated Lipocalin (NGAL), Kidney Injury Molecule-1 (KIM-1), Hepatocyte Growth Factor (HGF), Pi-Glutathione-S-Transferase (π-GST) and α-GST as markers of Acute Kidney Injury severity, at the time ofclinical creatinine increase, following adult cardiac surgery.

3) Diltiazem may preserve renal tubular integrity after cardiac surgery.
Piper, S.N., Kumle, B., Maleck, W.H., Kiessling, A.H., Lehmann, A., Röhm, K.D., Suttner, S.W. and Boldt,
J. (2003). Can. J. Anaesth. 50(3) 285-92

60 cardiac surgery patients studied.
Diltiazem use reduced post-operative increases in GSTs.

4) Is kidney function altered by the duration of cardiopulmonary bypass?
Boldt, J., Brenner, T., Lehmann, A., Suttner, S.W., Kumle, B. and Isgro, F. (2003). Ann. Thorac. Surg. 75(3) 906-12

50 subjects exposed to cardiopulmonary bypass for more than 90 minutes.
Longer bypass times were associated with increased urinary αGST and πGST at the end of surgery and during post operative days 1 and 2.

5) Renal tubular injury after infrarenal aortic aneurysm repair.
Cressey, G., Roberts, D.R. and Snowden, C.P. (2002). J. Cardiothoracic Vasc. Anesth. 2002 16(3) 290-3.

Intra surgical increases in αGST and πGST predicted increases in serum creatinine 1-2 days later.

6) Nephrotoxicity of Sevoflurane® versus Desflurane® in volunteers.
Eger II, E.I. et al. (1997). Anesthesia and Analgesia 84 160-168.

10 subjects exposed to Sevoflurane anaesthesia, 9 controls.
Urinary GSTs rose during and immediately following anaesthesia with Sevoflurane.
There were no changes in serum creatinine.

Animal Studies

1) Calpain inhibitor-1 reduces renal ischemia/reperfusion injury in the rat.
Chatterjee, P.K., Brown, P.A., Cuzzocrea, S., Zacharowski, K., Stewart, K.N., Mota-Filipe, H., McDonald, M.C. and Thiemermann, C. (2001) Kidney Int. 59(6) 2073-83.