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Ann Thorac Surg 2000;69:978
© 2000 The Society of Thoracic Surgeons

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Correspondence

Assessing renal function in "off-pump" versus "on-pump" coronary revascularization

^a Wessex Regional Cardiac & Thoracic Unit, Southampton General Hospital, Tremona Rd, Southampton, England S016 6YD, England, USA

To the Editor

We applaud the work performed by Ascione and associates on assessment of renal function after "beating heart" and "on-pump" coronary surgery [1]. However, we would like to raise two important points concerning the methodology employed. The first relates to an apparent lack of control for any nephrotoxic agent administered to the study cohort, such as nonsteroidal antiinflammatory drugs and inotropic agents. Perioperative administration of dopamine, in particular, has been shown to significantly enhance renal tubular injury suffered after coronary revascularization compared with placebo controls [2]. This factor alone could account for the entire difference observed in renal tubular function between the two groups [1]. Second, assessment of renal tubular injury using urinary excretion of N-acetyl glucosaminidase suffers from a relative lack of sensitivity. In contrast, urinary excretion of retinol binding protein (RBP) has been shown to be approximately 50 times more sensitive in this regard [3]. Combined with its exceptional stability in acidic urine, RBP assay is now generally regarded as a superior marker for clinical and experimental monitoring of renal tubular injury. It is therefore conceivable that any baseline difference in renal tubular dysfunction between the two groups could easily be masked by the use of an insensitive assay. The existence of disparate renal tubular function preoperatively would fundamentally alter the interpretation of subsequent findings. We would urge potential investigators who wish to further explore this field to consider using more sensitive methods.

References

1. Ascione R., Lloyd C.T., Underwood M.J., Gomes W.J., Angelini G.D. On-pump versus off-pump coronary revascularization. Ann Thorac Surg 1999;68:493-498.[Abstract/Free Full Text]
2. Tang A.T.M., El-Gamel A., Keevil B., Yonan N., Deiraniya A.K. The effect of ‘renal-dose’ dopamine on renal tubular function following cardiac surgery. Eur J Cardiothorac Surg 1999;15:717-722.[Abstract/Free Full Text]
3. Bernard A.M., Vyskocil A.A., Mahieu P., Lauwerys R.R. Assessment of urinary retinol-binding protein as an index of proximal tubular injury. Clin Chem 1987;33:775-779.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Augustine Tang Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Tang, A. Articles by Ohri, S. Search for Related Content PubMed Articles by Tang, A. Articles by Ohri, S. Related Collections Related Article