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నైరూప్య

The Effect of Preoperative Simvastatin on Heme Oxygenase-1 (HO-1), Plasma NGAL and the Incidence of Post-Operative Acute Kidney Injury in Patient Undergoing Exploratory Laparotomy Surgery

Erwin Pradian

Background: Stress due to surgical laparotomy causes the release of cytokine and inflammatory mediators which may increase the formation of Reactive Oxygen Species (ROS) and free heme plasma. Free heme plasma acts as a strong oxidant and may damage cells including the kidneys tubules causing Acute Kidney Injury (AKI) marked by an increase of Neutrophil Gelatinase Associated Lipocalin (NGAL). This heme oxidant is neutralized by Heme Oxygenase-1 (HO-1). Simvastatin is known to increase HO-1 gene expression and plasma level. The aim of this research is to determine the effect of preoperative simvastatin on HO-1 and NGAL plasma levels, and the AKI incidents on exploratory laparotomy surgery patients.

Methods: This research is a randomized control trial on patients undergoing laparotomy. Following approval from the ethics committee, patients was randomized into two groups, the control/placebo (C) group and trial group that were given Simvastatin 40 mg, with 16 patients in each group. NGAL dans HO-1 were evaluated before and after surgery, while creatinine and total urine output were measured before and 24 hours post-surgery. All patients were given a routine induction and general anesthesia protocol. NGAL, HO-1, creatinine and total urine were analyzed using multivariable statistical analysis.

Results: This article reports significant differences of NGAL and HO-1 between the two groups. In the control group, there was an increase of NGAL and decrease of HO-1. On the trial group, there was a no significant correlation with AKI, plasma creatinine and urine production 24 hour.

Conclusion: Simvastatin 40 mg has a protective effect on cell with increased plasma HO-1 in patients undergoing laparotomy.