AKI in Thoracic and Abdominal Surgery
AKI in Thoracic and Abdominal Surgery
The study will investigate the role of NSAIDs in the development of AKI in patients
 undergoing high-risk abdominal or thoracic surgery. The investigators hypothesize that the
 use of new urinary biomarkers will allow earlier detection of AKI than the current gold
 standard, i.e. changes in serum creatinine and/or urine output.
This study will be designed as a prospective observational trial. After obtaining
 Institutional Review Board (IRB) approval, patients will be recruited and consented from the
 Anesthesia Pre-Operative Clinic. On the day of surgery, baseline urine samples will be
 obtained at the initial insertion of the Foley catheter, after induction of anesthesia. Urine
 samples will also be collected from the Foley catheter in the immediate post-operative period
 shortly after the patient is admitted to the Intensive Care Unit (ICU). Urine samples will
 continue to be collected for 72 hours post-operatively, at 0600 (6am) and 1800 (6pm) each day
 from the indwelling Foley catheter, which is standard of care in the ICU. Urine samples will
 be labeled and stored as per the instructions provided in a commercially available kit; six
 urine samples total will be collected and stored per patient. The electronic medical record
 (EMR) will be reviewed to determine whether the patient received ketorolac, ibuprofen, or no
 NSAIDs intra-operatively and postoperatively (within 72 hours of the beginning of surgery).
 Daily serum creatinine measurements and hourly urine output, which are standards of care in
 the ICU, will be obtained from the EMR as well.

 AKI will be diagnosed and staged according to KDIGO criteria, which are based on changes in
 creatinine and urine output. In all patients with "KDIGO-diagnosed AKI" and in a matched
 non-AKI group, we will also compare the time course of new urinary biomarkers, including but
 not limited to uNGAL, to that of serum creatinine and urine output. We will match patients
 according to their demographics as well as clinical characteristics, including
 co-morbidities, type of surgery and anesthesia technique. Comparing the time course of
 current clinical markers (serum creatinine and urine output) with that of new urinary
 biomarkers will allow us to assess their role in guiding future preventive interventions.
Inclusion Criteria:

 -  age ≥ 21 (per manufacturer's instructions on the Nephrocheck kit)

 -  history of hypertension, whether medically treated or untreated

 -  scheduled for Anesthesia preoperative clinic visit

 -  scheduled to undergo prolonged intra-abdominal or intra-thoracic surgeries (defined as
 scheduled intraoperative time ≥ 4h). Intra-abdominal surgeries will include colorectal
 surgery, massive ventral hernia repairs, hepatobiliary surgery and
 gynecologic-oncology surgery. Intra-thoracic surgeries will include video-assisted
 thoracoscopic surgery (VATS)-assisted segmentectomy and lobectomies, as well as
 mediastinal mass excisions.

 -  will be anticipated to be admitted to the ICU for a minimum of 2-3 days
 post-operatively

 Exclusion Criteria:

 -  history of chronic kidney as defined by estimated glomerular filtration rate (GFR) <90

 -  patient taking NSAIDs on a daily basis

 -  patients with a reported allergy or intolerance to NSAIDs