Insight from the JCS 2025 Conference (October 17)
Insight from the JCS 2025 Conference (October 17)
Dr. Tanya Alhaj Hassan -Cardiac Intensivist
Topic: Renal Function Preservation After Cardiac Surgery
Session: Post-operative Cardiac ICU Management (Oct 17 2025)
1. Opening question
• She began by asking:
“What do you think is the best early marker of renal injury after cardiac surgery?”
• Audience replies included:
→ KFT (Creatinine, BUN) and urine output,
→ She noted both are late indicators, reflecting kidney damage after it has already occurred.
2. Classical vs modern concepts
• Traditional monitoring relies on creatinine rise > 48 h or urine output < 0.5 mL/kg/h, which delays recognition.
• 2025 consensus emphasizes “functional + structural” injury markers.
3. Emerging biomarkers (“Molecular 1 and 2”) – AKI panel
1. Molecular 1: Neutrophil Gelatinase-Associated Lipocalin (NGAL)
• Rises within 2–3 hours post-CPB.
• Predicts AKI 48 h earlier than serum creatinine.
2. Molecular 2: TIMP-2 × IGFBP-7 (Index of cell-cycle arrest)
• Detects tubular stress before irreversible injury.
• Incorporated into the 2025 KDIGO-AKI early-warning algorithm.
• Both now included in several peri-operative renal-risk scoring systems.
4. Clinical application in cardiac surgery
• High-risk groups: prolonged CPB, low cardiac output, ECMO, combined valve procedures.
• Use point-of-care urine NGAL/TIMP-2·IGFBP-7 assays for early identification.
• When positive → start “renal bundle” within 3 hours:
• optimize hemodynamics and perfusion pressure,
• avoid nephrotoxins,
• adjust diuretics & contrast use,
• guided fluid management (e.g., balanced crystalloids + dynamic preload assessment).
5. ICU integration and multidisciplinary care
• Cardiac intensivist, nephrologist, perfusionist, and ICU nursing team should act jointly.
• Biomarkers allow personalized renal protection rather than “one-size-fits-all.”
• Combined use with hemodynamic AI dashboards gives real-time risk visualization.
6. Key take-home messages
• Creatinine ↑ = too late → aim for molecular alerts within hours.
• Early recognition = renal recovery.
• 2025 era focus: move from AKI diagnosis to AKI prevention.
• Jordanian ICUs can pioneer regional adoption of molecular AKI panels within cardiac programs.