This study aims to investigate the predictive value of Doppler-based renal ultrasound and urinary oxygen tension in the development of acute kidney injury after cardiac surgery.
Age above 21 years.
Both sexes.
Undergoing elective on-pump cardiac surgery.
Patients with chronic kidney disease.
Patients with any renal pathology or anatomic kidney abnormalities.
Patients on renal replacement therapy.
This prospective cohort observational study will be conducted at Tanta University Hospitals for a period of at least two years, from October 2024 to September 2026, pending approval from the institutional ethics committee.
Cohort
Prospective
Renal resistive index
Other interventionIt will be measured with ultrasound-Doppler using an abdominal curvilinear probe ultrasonography by two independent, trained sonographers (who will not be involved in patient care). After visualizing the kidney in ultrasound mode and checking for renal abnormalities, an arcuate or inter-lobar artery will be localized, and three successive Doppler measurements at different positions in the kidney (high, middle, and low) will be performed. The average value for each kidney will be taken. The renal resistive index will be calculated as follows: (systolic peak flow velocity - diastolic minimum flow velocity)/systolic peak flow velocity
Renal Artery Pulsatility Index
Other interventionIt will be measured using an abdominal curvilinear probe ultrasonography by two independent, trained sonographers (who will not be involved in patient care). After visualizing the kidney, the interlobular artery will be located using color Doppler mode, and the velocity of the interlobular arteries will be assessed in one or two kidneys. The Renal Artery Pulsatility Index (RAPI) will be calculated as follows: RAPI = \[(peak systolic velocity) - (end diastolic velocity)\] /average velocity
Urinary oxygen tension (PUO2)
Other interventionUrinary oxygen tension (PUO2) will be measured preoperatively (baseline), postoperatively just after intensive care unit admission, 12 hours after surgery, and then once daily for 7 days.
Number of cases developed acute kidney injury
Number of cases developed acute kidney injury as defined by KIDGO guidelines (serum creatinine ≥ 0.3 mg/dL from base line within 48 hours, or ≥1.5 fold within 7 days, or urine output \<0.5 mL/kg/hour for six hours) in patients undergoing open heart surgery.
Length of intensive care unit stay
The length of stay in an Intensive Care Unit (ICU) is defined as the duration a patient spends in the ICU, typically measured from the time of admission to the ICU until the time of discharge.
Length of hospital stay
Length of hospital stay will be measured from admission till discharge from hospital.
Need for renal replacement therapy
Need for renal replacement therapy will be recorded.
Number of patients developed chronic kidney disease
Number of patients developed chronic kidney disease will be recorded.
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