الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Cardiac surgery-associated acute kidney injury is a common and serious postoperative complication of cardiac surgery that employs cardiopulmonary bypass. Risk factors for acute kidney injury are common among patients undergoing cardiac surgery. Many of these factors are not modifiable as elevated preoperative serum creatinine.
However, some factors may be potentially modifiable. These factors specifically related to the bypass procedure itself. Almost all of that risk factors relate to either impaired renal perfusion or decreased renal reserve.
Hemodynamic optimization is the cornerstone for acute kidney injury prevention. Consequently, perioperative hypotension should be avoided and a mean arterial pressure able to guarantee an adequate glomerular capillary filtration pressure. Several other supportive therapies have been proposed such as diuretics, statins, fenoldopam.
Some authors believed that the massive release of oxygen free radicals during the early phase of reperfusion is mostly the source for these injuries. So, several agents have been used to minimize that injury. N-acetylcysteine was among these agents.
as it has cytoprotective and microcirculatory effects that restore the cellular antioxidant potential by replenishing depleted reduced glutathione stores.
Sodium bicarbonate holds theoretical promise for preventing cardiac surgery associated acute kidney injury, especially with respect to protecting the vulnerable renal medulla through its ability to alkalinize tubular fluid and through reduction of free radical formation by neutralizing acidosis in this ischemic region of the kidney.
The current study was an interventional prospective comparative randomized study underwent on patients for elective cardiac bypass surgery after approval of medical ethical committee and obtaining written consent from the patient.
The current study showed that the more the bypass time, the more the time of aortic cross clamping, the lower the MAP during bypass, the more the liability to develop acute kidney injury after cardiac bypass surgery.
The current study showed that the more the rise in serum creatinine, the more the duration of mechanical ventilation, the more the length of stay in ICU and hospital.
The current study did not find a role of acetylcysteine and sodium bicarbonate in kidney protection after cardiac bypass surgery.