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Cystatin c and urinary enzymes for renal evaluation of pregnant women with and without pre-eclampsia submitted to CS under spinal anesthesia


Hypertensive diseases in pregnancy are one of the leading causes of maternal death. Among them, it is necessary to stress the pre-eclampsia syndrome due to its severity and the possibility of progression to more severe forms, such as eclampsia and HELLP syndrome. The hypertensive diseases may be associated with a decrease in renal function, especially in childbirth, when major hemodynamic changes may occur. Thus, the objective of this study is evaluate the glomerular filtration rate and tubular function through the measurement of cystatin C, urea, albumin and creatinine and plasma albumin, creatinine, alkaline phosphatase,-glutamyltransferase and urinary NGAL in 50 pregnant patients with (25) and without (25) pre-eclampsia undergoing cesarean section under neuraxial anesthesia. Inclusion criteria are: age between 18 and 40 years, body mass index between 22 and 30 kg/m2 and stature between 145 cm and 175 cm. Exclusion criteria are: hypovolemia, stillbirth, coagulation disorders, urinary tract infection, anuria, kidney transplants, acute or chronic renal failure and previous refusal to participate. A pre-anesthetic evaluation will be held, the patient monitoring will include continuous EKG, pulse oximeter and automatic sphygmomanometer. An 18 G catheter will be installed through venipuncture and a volume expansion with 500 ml of Ringer's lactate will be initiated. The patients will undergo spinal injection of 3 ml (15 mg) of hyperbaric bupivacaine 0.5% in the subarachnoid space. An indwelling catheter will be placed in all patients after spinal block. 10 ml blood and 50 ml of urine will be collected from all patients in the following periods: 1st period - during venipuncture and before neuraxial blockade, 2nd Period - 48 hours after cesarean section. There will be measured in the blood samples: 1 - cystatin C (turbidimetric method), 2 - creatinine, 3 - urea 4 - albumin. In the urine samples will be assayed: 1 - albumin 2 - NGAL 3 - alkaline phosphatase, 4 --glutamyltransferase (-GT) 20 and 5 - creatinine. The dosages of the urinary tract will be adjusted by urinary creatinine to eliminate the effect of urine dilution. Thus, the results of the urine measurements will be presented by the relationship: 1 - albumin / creatinine, 2 - alkaline phosphatase / creatinine and 3 - -GT/creatinine. The glomerular filtration rate will be evaluated by three formulas: Cockcroft-Gault, MDRD and Larsson. The renal function will be evaluated in the beginning of the surgery and 48 hours after the procedure. (AU)

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