WESTPORT, CT (Reuters Health) – The ratio of microalbuminuria to urinary creatinine (MACR), as a measure of glomerular permeability, shows a significant correlation with measures of the severity of surgical stress in children, according to Italian researchers.
Dr. Armando Sarti of IRCCS Burlo Garafolo in Trieste and colleagues note that studies "have shown a rise in urinary albumin after major surgery in adult patients." This rise, they add, "seems to be proportional to the magnitude of the surgical insult."
To determine if the same might true of younger patients, the researchers measured MACR before, during, and after elective "moderate or major" surgery in 40 children. At the end of procedure, surgical trauma was assessed by means of surgical stress scores.
In the August issue of Critical Care Medicine, the researchers observe that MACR "showed a progressive increase during surgery and a decrease afterward." Preoperative values were reached "in most cases" within 24 hours postoperatively. In addition, "there was a significant correlation between the increase in MACR and severity of the surgical trauma."
Furthermore, in three patients, MACR began to rise after the initial postoperative normalization. In two this was seen before the clinical appearance of a surgical complication. In the other patient, a persistent rise was seen before the clinical appearance of sepsis.
The researchers suggest that microalbuminuria "may be an early sign of incipient complications." They also point out that the procedure is a "cheap, blood-sparing, easy-to-perform" means of "evaluating the effect of surgical trauma on capillary permeability."