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The Journal of Thoracic and Cardiovascular Surgery, Vol 79, 838-844, Copyright © 1980 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
M Hilberman, GC Derby, RJ Spencer and EB Stinson
Sequential pathophysiological data were analyzed from 14 patients who
exhibited similar severe depression of cardiac and renal function within 24
hours of cardiac operation. Seven patients exhibited postoperative renal
dysfunction (defined by a minimum postoperative clearance of inulin [Cin]
between 20 ml/min/1.73 m2 and one-half normal) and seven progressed from
renal dysfunction to acute renal failure (ARF) (Cin less than or equal to
ml/min/1.73 m2). In ARF patients depression of cardiac function was
profound and persistent from postoperative days 1 to 7. Urine flow remained
greater than 1 ml/min, and serum creatinine rose progressively. The Cin
declined progressively during the first postoperative week. The ratio or
urinary to plasma osmolality fell, and the fractional excretion of sodium
(FENa) and potassium (FEK) increased substantially. By contrast, in renal
dysfunction patients definite hemodynamic improvement occurred and renal
function remained stable. Increased FENa in renal dysfunction was
associated with hemodynamic improvement, weight loss, and stable fractional
potassium excretion. These data provide unique documentation of the indices
of hemodynamic and renal function associated with the progression to
postoperative ARF. The central role of sustained profound depression of
cardiac function in this progression appears to be the primary factor in
the lethality of postoperative ARF.
ARTICLES
Sequential pathophysiological changes characterizing the progression from renal dysfunction to acute renal failure following cardiac operation
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