Postoperative Renal Function In Patients Research Articles

The Impact of Aprotinin on Renal Function After Liver Transplantation: An Analysis of 1043 Patients

Renal dysfunction is frequently seen after orthotopic liver transplantation (OLT). Aprotinin is an antifibrinolytic drug which reduces blood loss during OLT. Recent studies in cardiac surgery suggested a higher risk of postoperative renal complications when aprotinin is used. The impact of aprotinin on renal function after OLT, however, is unknown. In 1,043 adults undergoing OLT, we compared postoperative renal function in patients who received aprotinin (n = 653) or not (n = 390). Using propensity score stratification (C-index 0.82) and multivariate regression analysis, aprotinin was identified as a risk factor for severe renal dysfunction within the first week, defined as increase in serum creatinine by >or= 100% (OR = 1.97, 95% CI = 1.14-3.39; p = 0.02). No differences in renal function were noted at 30 and 365 days postoperatively. Moreover, no significant differences were found in the need for renal replacement therapy (OR = 1.52, 95% CI = 0.94-2.46; p = 0.11) or in 1-year patient survival rate (OR = 1.14, 95% CI = 0.73-1.77; p = 0.64) in patients who received aprotinin or not. In conclusion, aprotinin is associated with a higher risk of transient renal dysfunction in the first week after OLT, but not with a higher need for postoperative renal replacement therapy or an increased risk of mortality.

Oncological and Functional Outcome of Radical Cystectomy in Patients With Bladder Cancer and Obstructive Uropathy

We present our experience with the perioperative, functional and oncological outcomes of radical cystectomy in patients with bladder cancer and obstructive uremia. From 1998 to June 2006, 58 patients with bladder cancer, and concomitant obstructive uropathy and azotemia presented to our institution. Mean +/- SD serum creatinine at presentation was 9.2 +/- 4.5 mg% (range 2.4 to 16.5). Radical cystectomy, bilateral pelvic lymphadenectomy and urinary diversion were performed after stabilizing renal function with and without percutaneous nephrostomy in 28 and 8 patients, respectively. Various preoperative variables were evaluated for predicting long-term treatment failure and renal deterioration. Mean followup was 34 months. Mean serum creatinine at surgery was 1.85 mg%. An ileal conduit was used in 32 patients and cutaneous ureterostomy was used in 4. One patient died of chest infection in the perioperative period. All patients had muscle invasive disease, while 15 had positive lymph nodes. At the mean followup 15 patients (41.6%) were free of disease and 21 had treatment failure. Of the factors evaluated pathological tumor stage, grade and lymph node involvement predicted the long-term oncological outcome, while serum creatinine greater than 2.5 mg% at surgery and ileal conduit diversion predicted long-term renal deterioration. Patients with bladder cancer who have obstructive uremia usually present with locally advanced disease. Radical cystectomy is not associated with additional morbidity, provided that patients are adequately prepared before surgery by optimizing renal function. An adequate number of these patients achieve long-term disease-free survival after radical cystectomy. As the urinary diversion of choice, an ileal conduit appears to be safe in patients with serum creatinine less than 2.5 mg% at surgery.

Comparison of Laparoscopic Radical and Partial Nephrectomy: Effects on Long-Term Serum Creatinine

Laparoscopic partial nephrectomy (LPN) and radical nephrectomy (LRN) have been shown to be safe and effective treatment options for renal tumors. However, limited data are available regarding the long-term effect on postoperative renal function in patients undergoing LPN and LRN who have a normal preoperative serum creatinine (sCr) less than 1.5 mg/dL and a two-kidney system. We compared the long-term sCr in patients who were treated with LPN and LRN. From October 2002 to April 2006, a total of 93 and 171 patients with a single, unilateral, sporadic renal tumor, a normal contralateral kidney and sCr less than 1.5 mg/dL underwent LPN and LRN, respectively. Perioperative, pathologic data and sCr at least 6 months after surgery were compared between the two groups. A total of 42 and 55 patients with at least 6 months of follow-up after LPN and LRN were evaluated. Tumors treated with LPN were significantly smaller (2.4 versus 5.4 cm, P <0.001) than those in the LRN group. The mean age, body mass index, sex, tumor location, and sCr (0.91 and 0.91 mg/dL, P = 0.93) were similar between the two groups. The mean operative time was longer for LPN (222 versus 182 minutes, P = 0.002) with a mean warm ischemia time of 37 minutes (range 13 to 55). The mean 6-month sCr was significantly greater for patients undergoing LRN (1.4 versus 1.0 mg/dL, P <0.001). Similarly, a greater number of LRN patients developed renal insufficiency (sCr 1.5 mg/dL or greater) compared with LPN (36.4% versus 0%, P <0.001). Despite the warm ischemia and longer operative times, LPN preserves the kidney function better than LRN. In properly selected patients, LPN should be preferentially performed to prevent chronic renal insufficiency.

Estimated creatinine clearance instead of plasma creatinine level as prognostic test for postoperative renal function in patients undergoing coronary artery bypass surgery☆

Preoperative renal failure is a risk factor for adverse events in cardiac surgery. Serum creatinine (SCr) is the most used test for renal failure. However, patients can have significantly decreased glomerular filtration rates with normal SCr levels. More accurate approximation of renal function can be obtained using the Cockroft-Gault equation to calculate an estimated creatinine clearance (CrCl) rate from SCr. This study included 627 patients undergoing an isolated CABG between January 2003 and September 2004. CrCl was calculated using the Cockroft-Gault formula. Patients were divided in group A-SCr, 576 patients (91.1%) with a good renal function, SCr < or =1.20 mg/dL for women and < or =1.40 mg/dL for men, and a group B-SCr, with impaired renal function, 51 patients (8.1%). CrCl < or = 50 mL/min was chosen to reflect renal impairment. Group A-CrCl (555 patients, 88.5%) had a normal renal function and group B-CrCl (72 patients,11.5%) an impaired renal function. The studied outcomes were hospital mortality, hospital morbidity, and postoperative renal failure. There was no statistical significant difference between A-SCr and B-SCr group according to the studied outcomes. On the contrary, using the CrCl there was a statistical significant difference between A-CrCl and B-CrCl for the percentage of postoperative renal failure 10 patients (1.8%) versus 5 patients (6.9%) (p=0.00), hospital morbidity 75 patients (13.5%) versus 16 patients (22.2%) (p=0.04). Hospital mortality, 11 patients (2%) versus 4 patients (5.6%), was not significantly (p=0.06) different. Postoperative dialysis, four patients (0.7%) versus three patients (4.2%) (p=0.00), stroke, three patients (0.5%) versus three patients (4.2%) (p=0.00), and hospital stay (7.6 days vs 11.0 days) (p=0.01) were significantly different. This study documents that the association between preoperative renal failure and adverse outcomes after CABG is stronger with the estimated CrCl than with the routinely used SCr. Routine estimation or measurement of glomerular filtration rate should be preferred to SCr as screening method for the detection of higher risk patients undergoing CABG.

The effect of preoperative bile salt administration on postoperative renal function in patients with obstructive jaundice

We have studied the effect of the preoperative administration of bile salts on postoperative renal function in jaundiced patients undergoing surgery. Nine patients did not receive bile salts and in this group there were 2 cases of acute renal failure in the postoperative period. Furthermore, creatinine clearance values fell in this group from a mean value of 85 ml/min preoperatively to a mean postoperative value of 55 ml/min. Nine patients received preoperative bile salts with no case of renal failure. Creatinine clearance values increased in all but 2 patients from a mean preoperative value for the group 79 ml/min to a mean postoperative value for the group of 99 ml/min. The difference between the changes in creatinine clearance in the two groups was statistically significant (P less than 0.01). The results of this study suggest that the oral administration of bile salts to jaundiced patients in the preoperative period prevents deterioration in renal function postoperatively and also reduces the incidence of postoperative renal failure.

Prediction of postoperative renal function by preoperative serum creatinine level and three-dimensional diagnostic image reconstruction in patients with renal cell carcinoma

ObjectivesTo investigate retrospectively whether postoperative renal function in patients with renal cell carcinoma can be preoperatively predicted by a combination of the preoperative serum creatinine (sCr) and the renal parenchymal volume (RPV) estimated by three-dimensional image reconstruction of the preoperative diagnostic imaging. MethodsOf 155 patients who had undergone radical nephrectomy, 76 were eligible for inclusion in our study (group 1). Group 2 was comprised of 26 of 37 patients who had undergone partial nephrectomy. The postoperative RPV in both groups was estimated from the preoperative computed tomography scans or magnetic resonance imaging and were compared with the actual RPV estimated from the postoperative imaging using a three-dimensional image reconstruction program. The postoperative creatinine clearance (Ccr) was predicted from the preoperative Ccr calculated from the sCr level and by the ratio of the postoperative/preoperative RPV. The correlations between the predicted postoperative Ccr and the actual, measured postoperative Ccr were analyzed statistically. ResultsIn both groups, a statistically significant correlation was found between the postoperative RPV, estimated from the preoperative images and postoperative images. The predicted postoperative Ccr correlated significantly with the actual, measured postoperative Ccr in group 1 (r = 0.86, P <0.0001) and group 2 (r = 0.98, P <0.0001). The postoperatively increased sCr achieved stable levels within 2 to 4 weeks after nephrectomy and showed no statistically significant subsequent changes during 3 years of follow-up. ConclusionsThe present results demonstrated that prediction of the postoperative Ccr, using the preoperative sCr and the postoperative RPV estimated from the preoperative routine diagnostic imaging, is a simple and reliable method for the evaluation of early and medium-term postoperative renal function.

The Effect of a Fenoldopam Infusion on Postoperative Renal Function in Patients Undergoing Liver Transplantation

The Effect of a Fenoldopam Infusion on Postoperative Renal Function in Patients Undergoing Liver Transplantation

THE EFFECT OF DOPAMINE ON RENAL FUNCTION IN SOLITARY PARTIAL NEPHRECTOMY SURGERY

Dopamine continues to be used for preventing and treating acute renal failure. We determined the effects of dopamine on postoperative renal function in patients with a solitary kidney undergoing partial nephrectomy. We performed a prospective randomized controlled study at a tertiary care referral center involving 24 patients with a solitary kidney undergoing partial nephrectomy secondary to malignancy. Patients were randomized to receive dopamine (11) [corrected] or no dopamine (13) [corrected]. Intraoperatively those assigned to the dopamine group received a 3 microg./kg. per minute dopamine infusion. Patients in each group received an adequate amount of fluid to maintain good urine production, systemic blood pressure and central venous pressure. Serum electrolytes, blood urea nitrogen, creatinine, serum and urine osmolality, and urine output were measured at baseline, intraoperatively and through postoperative day 4. Preoperatively and postoperatively renal blood flow and the glomerular filtration rate were measured. In the 2 groups blood urea nitrogen and serum creatinine increased postoperatively. Although the degree of this increase showed a trend to be lower in the dopamine group, the difference did not reach statistical significance. There was no difference in renal blood flow or the glomerular filtration rate in the treatment groups. Administering dopamine to patients with a solitary kidney undergoing partial nephrectomy provided no renoprotective effect.

Intraoperative Urinary Output Does Not Predict Postoperative Renal Function in Patients Undergoing Abdominal Aortic Revascularization

Intraoperative Urinary Output Does Not Predict Postoperative Renal Function in Patients Undergoing Abdominal Aortic Revascularization