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LETTER TO EDITOR
J Res Med Sci 2017,  22:119

Does zinc possess renoprotective properties in patients under cardiac surgery?


Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Mazandran University of Medical Sciences, Sari, Iran

Date of Web Publication31-Oct-2017

Correspondence Address:
Seyed Mahmood Nouraei
Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Mazandran University of Medical Sciences, Sari
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrms.JRMS_423_17

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How to cite this article:
Nouraei SM. Does zinc possess renoprotective properties in patients under cardiac surgery?. J Res Med Sci 2017;22:119

How to cite this URL:
Nouraei SM. Does zinc possess renoprotective properties in patients under cardiac surgery?. J Res Med Sci [serial online] 2017 [cited 2017 Nov 19];22:119. Available from: http://www.jmsjournal.net/text.asp?2017/22/1/119/217468



Sir,

Acute kidney injury (AKI) is a serious and common postoperative complication of cardiac surgery (CS) with incidence and mortality rate. The most prominent pathologic mechanism of AKI following CS is acute tubular necrosis.[1] The inflammatory responses, the production of free radicals, and tubular oxidative stress, which are triggered by CS, play an important role in the tubular necrosis.[2] Hence, it seems that the modification of inflammatory responses and reduction of renal tubular oxidative stress become main therapeutic targets. No proven intervention has demonstrated a definitive renal protection during CS, so far. Some pharmacological agents have revealed protective benefits on renal function; however, the current evidence is controversial. Therefore, finding effective and promising interventions for preventing this complication remains a priority for future research.

Following stress and trauma such as CS, the induction of acute phase response, and production of proinflammatory cytokines redistribute micronutrients from the vascular compartment; consequently, the plasma concentration of micronutrients is declined.[3] In these cases, evidence suggesting supplementation with antioxidant and anti-inflammatory micronutrients such as zinc can form antioxidant defense mechanisms, downregulate cytokine production, and decline cytokine concentrations and hence can reduce oxidant injury to cells and organs.[3],[4] Since several renal diseases are mediated by oxidant injury, decreasing the production of reactive oxygen molecules or treating with antioxidant agents may open new avenues for research into therapeutic intervention.[5]

Zinc is capable of decreasing postischemic injury to different organs such as kidney. It can antagonize the transition of metal-catalyzed reactions and reduce the formation of hydroxyl radical from hydrogen peroxide.[4] However, its effectiveness has not been tested in a trial regarding CS-associated AKI. Berger et al.[3] found that antioxidant supplementation could significantly reduce the inflammatory responses in patients under CS.

Finally, zinc possesses an antioxidant and anti-inflammatory properties; it is safe, nontoxic, inexpensive, and widely available antioxidant. Therefore, its effectiveness and efficacy should be evaluated in future trials to find answer to this question: Does zinc possess renoprotective properties in patients under cardiac surgery?

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ortega-Loubon C, Fernández-Molina M, Carrascal-Hinojal Y, Fulquet-Carreras E. Cardiac surgery-associated acute kidney injury. Ann Card Anaesth 2016;19:687-98.  Back to cited text no. 1
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2.
Gaffney AM, Sladen RN. Acute kidney injury in cardiac surgery. Curr Opin Anaesthesiol 2015;28:50-9.  Back to cited text no. 2
    
3.
Berger MM, Soguel L, Shenkin A, Revelly JP, Pinget C, Baines M, et al. Influence of early antioxidant supplements on clinical evolution and organ function in critically ill cardiac surgery, major trauma, and subarachnoid hemorrhage patients. Crit Care 2008;12:R101.  Back to cited text no. 3
    
4.
Rao K, Sethi K, Ischia J, Gibson L, Galea L, Xiao L, et al. Protective effect of zinc preconditioning against renal ischemia reperfusion injury is dose dependent. PLoS One 2017;12:e0180028.  Back to cited text no. 4
    
5.
Ali-Hassan-Sayegh S, Mirhosseini SJ, Tahernejad M, Mahdavi P, Shahidzadeh A, Karimi-Bondarabadi AA, et al. Impact of antioxidant supplementations on cardio-renal protection in cardiac surgery: An updated and comprehensive meta-analysis and systematic review. Cardiovasc Ther 2016;34:360-70.  Back to cited text no. 5
    




 

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