Methylprednisolone favourably alters plasma and urinary cytokine homeostasis and subclinical renal injury at cardiac surgery.

摘要: Abstract Whilst elevated urinary transforming growth factor beta-1 (TGFβ) is associated with chronic renal dysfunction its role in acute peri-operative unknown. In contrast, increases IL-1 receptor antagonist (IL-1ra) and TNF soluble receptor-2 (TNFsr-2) mirror pro-inflammatory activity the nephron correlate complications. Steroids modulate some plasma cytokines (decreasing TNFα, IL-8, IL-6 increasing IL-10), whereas ability to reduce TNFsr-2 IL-1ra injury Patients undergoing coronary artery bypass grafting cardiopulmonary (CPB) were randomised receive methylprednisolone ( n =18) or placebo =17) before induction of anaesthesia. Plasma pro- anti-inflammatory cytokine balance was determined along subclinical proximal tubular dysfunction, measured by N -acetyl-β- d -glucosaminidase (NAG)/creatinine α-1-microglobulin/creatinine ratios, respectively. control group compared baseline, IL-10, significantly IL-1ra, TGFβ1. Urinary NAG/creatinine ratios rose from completion revascularisation until 6 h recovery at 24 h a further rise ratio 48 h. Compared placebo, showed reduced IL-10 increased. demonstrated ratio, TGFβ1 Conclusions Methylprednisolone administration during cardiac surgery reduces but not dysfunction.