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BackgroundIn patients undergoing orthopaedic trauma surgery, acute kidney injury (AKI) can develop post-operatively and is a major cause of increased mortality and hospital stay time. Development of AKI is associated with three main processes: inflammation, ischaemia-reperfusion injury (IRI) and hypoperfusion. In this study, we investigated whether ratios of urine and blood anti-inflammatory biomarkers and biomarkers of hypoperfusion, IRI and inflammation are elevated in patients who develop post-trauma orthopaedic surgery acute kidney injury (PTOS-AKI).MethodsBlood and urinary biomarkers of inflammation, hypoperfusion and IRI were analysed in 237 patients undergoing orthopaedic fracture surgery pre- and post-operatively. Biomarker ratios were compared between non-PTOS-AKI and PTOS-AKI patients.ResultsMultiple inflammatory biomarkers were significantly elevated in PTOS-AKI patients compared to non-PTOS-AKI patients. When urine anti-inflammatory biomarkers were expressed as biomarker ratios with biomarkers of inflammation, hypoperfusion and IRI, multiple ratios were lower in PTOS-AKI patients. In contrast, blood anti-inflammatory biomarkers when expressed as ratios with blood proinflammatory biomarkers were elevated in PTOS-AKI patients.DiscussionReductions in ratios of urine anti-inflammatory and proinflammatory biomarkers in PTOS-AKI patients suggest that the renal anti-inflammatory response is protective against the proinflammatory response in patients who do not develop PTOS-AKI. Detection of proinflammatory and anti-inflammatory biomarkers both pre- and post-operatively may be useful in detecting patients at risk of developing AKI after orthopaedic surgery.

Abstract Background Increased perioperative pro-inflammatory biomarkers, renal hypoperfusion and ischemia reperfusion injury (IRI) heighten cardiac surgery acute kidney injury (CS-AKI) risk. Increased urinary anti-inflammatory cytokines attenuate risk. We evaluated whether blood and urinary anti-inflammatory biomarkers, when expressed as ratios with biomarkers of inflammation, hypoperfusion and IRI are increased in CS-AKI patients. Methods Preoperative and 24-h postoperative blood and urinary pro-inflammatory and anti-inflammatory cytokines, blood VEGF and H-FABP (hypoperfusion biomarkers), and MK, a biomarker for IRI, were measured in 401 cardiac surgery patients. Pre- and postoperative concentrations of biomarkers and selected ratios thereof, were compared between non-CS-AKI and CS-AKI patients. Results Compared with non-CS-AKI, blood pro-inflammatory (pre- and post-op TNFα, IP-10, IL-12p40, MIP-1α, NGAL; pre-op IL-6; post-op IL-8, MK) and anti-inflammatory (pre- and post-op sTNFsr1, sTNFsr2, IL-1RA) biomarkers together with urinary pro-inflammatory (pre- and post-op uIL-12p40; post-op uIP-10, uNGAL) and anti-inflammatory (pre- and post-op usTNFsr1, usTNFsr2, uIL-1RA) biomarkers, were significantly higher in CS-AKI patients. Urinary anti-inflammatory biomarkers, when expressed as ratios with biomarkers of inflammation (blood and urine), hypoperfusion (blood H-FABP and VEGF) and IRI (blood MK) were decreased in CS-AKI. In contrast, blood anti-inflammatory biomarkers expressed as similar ratios with blood biomarkers were increased in CS-AKI. Conclusions The urinary anti-inflammatory response may protect against the injurious effects of perioperative inflammation, hypoperfusion and IRI. These finding may have clinical utility in bioprediction and earlier diagnosis of CS-AKI and informing future therapeutic strategies for CS-AKI patients.

Background: Protection of nuclear medicine unit employees from hazards of the ionizing radiation is a crucial issue of radiation protection services. We aimed to assess the severity of the occupational radiation exposure of technicians performing scintigraphic examinations at the Nuclear Medicine Department, Central Teaching Hospital of Medical University in Łódź, where thousands of different diagnostic procedures are performed yearly. Materials and Methods: In 2013 the studied diagnostic unit has employed 10 technicians, whose exposure is permanently monitored by individual dosimetry. We analyzed retrospective data of quarterly doses in terms of Hp(10) dose equivalents over the years 2001-2010. Also annual and five-year doses were determined to relate the results to current regulations. Moreover, for a selected period of one year, we collected data on the total activity of radiopharmaceuticals used for diagnostics, to analyze potential relationship with doses recorded in technicians performing the examinations. Results: In a 10-year period under study, the highest annual dose recorded in a technician was 2 mSv, which represented 10% of the annual dose limit of 20 mSv. The highest total dose for a 5-year period was 7.1 mSv, less than 10% of a 5-year dose limit for occupational exposure. Positive linear correlation was observed between total activity of radiopharmaceuticals used for diagnostics in the period of three months and respective quarterly doses received by technicians performing examinations. Conclusions: Doses received by nuclear medicine technicians performing diagnostic procedures in compliance with principles of radiation protection are low, which is confirmed by recognizing the technicians of this unit as B category employees. Med Pr 2013;64(4):503–506