Postoperative acute renal failure is a major problem in surgical patients and may result from varieties of prerenal, renal, and postrenal causes. Mortality of this disorder was distressingly high despite improvement in dialysis and intensive
general
care.
Clinical data from31 patients with postoperative acute renal failure treated between 1989 and 1993 were reviwed.
@ES The results were summerized as follows:
@EN 1) There were 16 men and 15 women with a median age of 49 yerars. Twenty one(68%) of 31 patients were over 50 years old.
General surgery 14 cases(45%). Cardiac surgery 11 cases(35%), neurologic surgery 3 cases, orthopedic surgery 2 cases and gynecologic surgery 1 case were performed.
Preoperative clinical characteristics were over 50 years old in 21 cases(68%), antibiotics in 9 cases(29%). Infections in 6 cases, hypertention in 5 cases, diabetes mellitus in 4 cases, radiocontrast agent in 3 cases, jaundice in 3 cases,
jaundice
in 3
cases, cardiovascular disease in 3 cases, emergency operation in 10 cases(32%), and trauma in 4 cases.
Perioperative hypotension was 9 cases(29%) and massive blood transfusion was 20cases(65%). Fourteen of the 31 patients(45%) received intraoperative diuretics, and twenty of 31 patients(65%) received diuretics within 24 hours after operation.
Enflurane(65%) was the most commonly used anesthetic, followed by intravenous anesthetics(16%), isoflurane(10%), and halothane(10%).
When acute renal failure was diagnosed, urinalysis showed gross or microhematuria in 27 cases(87%), pyuria in 10 cases(32%), and proteinuria in 21 cases(68%). Urine specific gravity in 7 patients(23%) were below 1.010. Routine CBC showed anemia
less
than 10 g/dl in 16 cases(52%). And thrombocytopenia less than 50,000/mm³ in 10 cases(32%). During postoperative period blood chemistry showed elevated BUN in most of the cases. BUN levels in 20 cases(65%) were above 60 mg/dl and serum creatinine
levels
in 26 cases(84%) were above 3mg/dl. Serum sodium levels in 4 cases were below 125 mEq/L and serum potassium levels in 11 cases(35%) were above 6 mEq/L.
nineteen(61%) of 31 patients were nonoliguric type, nine(29%) were oliguric type and three(10%) were anuric type. Fourteen(45%) of 31 patients underwent hemodialysis.
Postoperative complications were developed in 25 cases(81%) and pulmonary complications were most common.
Median time interval between onset of acute renal failure and death was 18 days(range, 3 to 45 days) and median time to recovery was 24 days(range, 3 to 72 days).
Twenty(64%) of 31 patients were died. Main causes of death were respiratory failure, cardiac failure and sepsis. The high mortality rate was seen in patients with abdominal operation(79%), postoperative complications(80%), over 50 years old(71%)
and
oliguric(78%) or anuric(100%) renal failure.
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