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Background: Acute Kidney Injury is a complication in children with heart disease undergoing cardiac surgery with cardiopulmonary bypass. The aim of this study is to describe the behavior of KIM-1 (Kidney Injury Molecule) and NGAL (Neutrophil Gelatinase Associated Lipocalin) as early predictors of renal damage, comparing them with serum creatinine and creatinine clearance, in neonates undergoing cardiac surgery., Methods: Twenty-one (21) neonates, under 4 kg, with complex congenital heart diseases, RACHS-1 > 3, without preoperative renal failure, were studied. Serum creatinine and creatinine clearance were measured preoperatively and at 24, 48, 72, 96 hours postoperatively. Urinary samples of KIM-1(pg/ml) and NGAL (ng/ml) were collected after induction of anesthesia at 24 and 48 hours post-operatively., Results: nRIFLE criteria were used to divide cohorts in "NO AKI" (12 patients) and "AKI" (nine patients). In the AKI group, serum creatinine increased significantly and creatinine clearance decreased significantly at 24, 48, and 72 hours compared with their respective baseline values. There was no difference in KIM-1 and NGAL values between patients who developed AKI and those who did not at any measured time., Conclusions: The deterioration of renal function continues to be one of the most frequent complications in this population. In our study, biomarkers did not show any correlation with the appearance of AKI. It remains to be seen whether this behavior of the biomarkers is linked with the non-consistent release of these types of molecules in immature kidneys. It is likely that a larger panel of biomarkers together with other glomerular filtration rate assessment methods will provide more information about AKI diagnosis.

Cardiac surgery with cardiopulmonary bypass is associated with systemic inflammatory response. In some cases this clinical condition is characterized by severe hypotension due to low systemic vascular resistance during and after cardiopulmonary bypass. A few of these cases do not respond to volume or catecholamines. This condition is known as vasoplegic syndrome. Its etiology is not fully understood today and carries associated morbidity and mortality In this syndrome, vasopressin levels are reduced, as in septic and hypovolemic shock. Supplementary vasopressin improves blood pressure and might be considered as an alternative treatment. Several reports have shown benefits when used alone or in combination with catecholamines. However, further studies are necessary to find the most appropriate use of the drug for vasoplegic syndrome.

Objective: Renal vasoconstriction has been blamed as a cause of perioperative renal dysfunction after cardiac surgery. Endothelial function is a critical determinant of vascular tonus, including vasoconstriction. The objective of this study was to establish whether the release of the endothelial vasodilator nitric oxide (NO) or NO products is altered in patients undergoing surgery with cardiopulmonary bypass in 3 different clinical conditions., Design: Observational and randomized prospective study., Setting: University hospital., Participants: Adults and pediatric patients undergoing elective cardiac surgery with cardiopulmonary bypass., Interventions: Three groups of patients were studied: group 1, 10 patients undergoing elective coronary artery surgery; group 2, 20 patients undergoing elective coronary artery surgery randomized to 2 hematocrit values during cardiopulmonary bypass, high (27%) and low (23%); and group 3, 10 pediatric patients undergoing surgical repair of noncyanotic cardiac defects., Measurements and Main Results: NO products (NO2 + NO3) and cyclic guanosine monophosphate (cGMP) in urine were measured before, during hypo- and normothermic cardiopulmonary bypass, and 1 hour postoperatively. Filtration fraction was calculated. The glomerular filtration rate and effective renal plasma flow were measured with inulin and (131)I-hippuran clearances, respectively. Urinary alpha glutathione s-transferase was measured pre- and postoperatively in groups 1 and 3. NO products, as well as cGMP, decreased significantly during hypo- and normothermic cardiopulmonary bypass in all groups. This was not because of urine dilution or the degree of hemodilution. Age did not appear to alter this response. Filtration fraction decreased during cardiopulmonary bypass. Alpha glutathione s-transferase was normal pre-and postoperatively., Conclusions: Cardiac surgery with cardiopulmonary bypass is associated with a significant decrease of NO products. In the absence of kidney damage, decreased NO products could represent a physiologic response to cardiopulmonary bypass; however, endothelial dysfunction cannot be excluded.

Background: Patients with valvular heart disease are at high risk of acute renal failure after surgery with extracorporeal circulation., Aim: To describe changes in renal function parameters during surgery with extracorporeal circulation in patients with valvular heart disease and compare them with those found in patients undergoing elective coronary surgery., Material and Methods: Two groups of patients were studied. Group 1 was composed by twelve patients undergoing elective coronary surgery and group 2 was composed by eleven patients undergoing surgery for heart valve replacement. Glomerular filtration rate and effective renal plasma now were estimated from inulin and the 131 I-hippuran clearance respectively, at five different times, during surgery and the postoperative period. Sodium filtration fraction and fractional excretion were calculated. Alpha and pi-glutathione s-transferase in urine were measured as markers of tubular damage in the pre and postoperative periods., Results: Effective renal plasma flow was reduced in both groups before induction of anesthesia, did not change during surgery and decreased significantly in patients with valvular disease in the postoperative period. Glomerular filtration rates were normal during all the study period. There was a non significant reduction of filtration fraction during extracorporeal circulation. Alpha and pi glutathione s-transferases were normal and did not change. Fractional excretion of sodium increased significantly postoperatively., Conclusions: In patients with valvular disease undergoing surgery with extracorporeal circulation, renal function does not deteriorate. No significant difference was found when compared with patients undergoing coronary surgery. No evidence of functional and cellular renal disfunction or damage was found in both study groups.