Oliguric acute renal failure following cardiac surgery
Takagi, I.; Tanaka, K.; Kumon, K.; Aono, N.; Tomino, T.; Naito, Y.; Fujita, T.
Nihon Kyobu Geka Gakkai 33(6): 884-888
1985
ISSN/ISBN: 0369-4739 PMID: 4056504 Document Number: 258121
Among 446 patients requiring cardiac surgery in 1982, 34 patients developed ARF (serum creatinine .gtoreq. 2.0 mg/dl) postoperatively. A retrospective, comparative study on those patients was the base of this report. The overall incidence of ARF was 7.6%. Thirty-four patients were classified into two groups, those with oliguric acute renal failure (O-ARF, n = 5) and those non-oliguric acute renal failure (N-ARF, n = 29). Oliguria was defined as a daily urine output of less than 500 ml/day/1.48 cm2. The mortality rate of O-ARF group was 20% and N-ARF was 10.3%. In O-ARF group, the duration of cardiopulmonary bypass (CPB) was significantly longer compared to those in N-ARF group. Although there was no significant difference in pre-operative renal functions between the two groups, serum creatinine increased more rapidly immediately after cessation of CPB and creatinine clearance (Ccr) of first operative day was significantly low in O-ARF group. In 12 patients of ARF showing Ccr of first operative day of less than 30 ml/min/1.48 m2, 4 patients developed O-ARF and 8 patients developed N-ARF. It was found that the development of O-ARF was influenced by hemodynamic deteriorations such as low cardiac output and/or severe arrhythmia. Therefore, for the prevention of postoperative O-ARF, it appeared to be quite important to maintain stable hemodynamic all through intra- and postoperative periods.