title: The effect of infrarenal aortic reconstruction on glomerular filtration rate and effective renal plasma flow.
abstract: Compromised patients with aortic disease are vulnerable to various complications from aortic reconstruction. These complications are related to changes in systemic haemodynamics during aortic cross-clamping, which leads to cardiac stress and alteration in regional blood flow to different organs. One of the most important postoperative complications is renal failure which is associated with a high mortality rate. Circulatory alterations within the kidney must play a role in the pathogenesis of renal dysfunction that may follow infrarenal aortic cross-clamping and reconstruction. To study the effects of abdominal aortic reconstruction on renal function and perfusion, we measured prospectively the glomerular filtration rate (GFR, n = 59), effective renal plasma flow (ERPF, n = 38) and left ventricular ejection fraction (LVEF, n = 38) in patients undergoing elective infrarenal aortic reconstruction. Radionuclide techniques were used. The three parameters were measured at three time points: preoperatively, postoperatively and 6 months after surgery. The LVEF was measured in order to reflect the patient's cardiac status and pre-renal perfusion. We also measured the three parameters in two control groups of patients: a group of patients undergoing major colonic surgery and a group of patients with arterial disease under conservative management. Six months after surgery the GFR had decreased in 67% of aortic reconstruction patients. Overall GFR in the aortic reconstruction group decreased by a mean of 9 ml min-1 (p = 0.007). This was associated with a decrease in the ERPF in 48.5% of patients. The mean decrease in ERPF in the aortic reconstruction group was 74 ml min-1 (p = 0.05). The LVEF was unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of General Surgery, Walsgrave Hospital, Coventry, U.K.
authors.forename: R W
authors.initials: RW
authors.lastname: Awad
authors.forename: W J
authors.initials: WJ
authors.lastname: Barham
authors.forename: D N
authors.initials: DN
authors.lastname: Taylor
authors.forename: D A
authors.initials: DA
authors.lastname: Woodward
authors.forename: B R
authors.initials: BR
authors.lastname: Bullen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000503:physiopathology / Q000601:surgery; D001014:Aortic Aneurysm / Q000503:physiopathology / Q000601:surgery*; D001783:Blood Flow Velocity / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D015179:Colorectal Neoplasms / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007511:Ischemia / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000098:blood supply*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*; D012016:Reference Values; D012039:Regional Blood Flow / Q000502:physiology