Clinical data from 43 patients with postoperative acute renal failure treated between 1984 and 1991 were reviewed. There were 26 men and 17 women with a median age of 51 years (range, 17 to 79). Primary diseases operated were trauma(15 cases),
gastroduodenal(13 cases), hepatobiliary (12 cases) and colorectal origins(3 cases). Emergency operation had been performed in 24 cases(56%) and elective in 19 cases(44%). Associated conditions were retroperitoneal hematoma, cardiovascular disease
and
sepsis(8 cases, respectively), remainders were liver cirrhosis(4 cases), pulmonary disease(3 cases) and diabetes mellitus(2 cases).
Oliguric renal failure was 28 cases(65%), and nonoliguric, 15 cases(35%).
Urinalyses showed gross or microhematuria in 38 cases(88%), WBC>10/(HFP) in 26 cases(60%), proteinuria in only 13 cases(30%) and specific gravity of diverse value. Routine CBD showed anemia in 27 cases(63%), leukocytosis in 25 cases(58%), and
thrombocytopenia less than 50,000/㎣ in 18 cases942%). Blood chemistry showed elevated BUN in almost all cases and creatinine in 36 cases(84%), but hyponatremia or hyperkalemia were not constant. Perioperative massive blood transfusions over 10
pints
had been required in 20 cases(47%). Median time interval between operation and onset of renal failure and recovery wer 2 days(range, 1 to 8 days) and 14 days(range, 8 to 19 days) respectively. Conservative treatment was performed in 28
cases(65%),
and
hemodialysis in 15 cases(35%).
Overall mortality rate was 60%. Main causes of death were respiratory failure, sepsis, and cardiac failure Median time to death was 5 days9range, 1 to 14 days).
Mortality rate was higher in patients with emergency operation associated condition, perloperative hypotension, massive blood transfusion and oliguric renal failure(p<0.05, respectively). It is concluded that mortality in patietns with
postoperative
renal failure is still so high despite of current intensive care that early recognition and proper correction of prerenal condition are crucial to prevent organic renal damage.
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