Detection of renal blood flow abnormalities in septic and critically ill patients using a newly designed indwelling thermodilution renal vein catheter.
To evaluate alterations in renal blood flow in sepsis-induced renal failure, we developed and studied a percutaneously placed thermodilution renal blood flow catheter in eight critically ill patients. Para-aminohippurate extraction coefficients were decreased, supporting the need for renal vein sampling to determine CPAH in sepsis. Thermodilution and CPAH methods correlated strongly, confirming the reliability of this thermodilution method. Renal vascular resistance, an indicator of renal vascular function, remained unchanged throughout the bouts of sepsis. The fraction of total body arterial blood flow going to the kidneys rose significantly during recovery from sepsis. Glomerular filtration rate, which was reduced in four of seven septic patients, correlated with the fraction of total blood flow going to the kidneys. These results suggest that renal vascular abnormalities may be occurring during septic shock. Our study demonstrates that sepsis-induced renal dysfunction may occur despite normal ranges of total renal blood flow during shock.
Brenner
M
M
Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD.
Schaer
G L
GL
Mallory
D L
DL
Suffredini
A F
AF
Parrillo
J E
JE
D058186:Acute Kidney Injury / Q000209:etiology; D002138:Calibration; D002395:Catecholamines / Q000627:therapeutic use; D002408:Catheters, Indwelling; D004756:Enterobacteriaceae Infections / Q000503:physiopathology; D004867:Equipment Design; D005919:Glomerular Filtration Rate / Q000502:physiology; D006439:Hemodynamics; D006801:Humans; D012079:Renal Circulation / Q000502:physiology*; D012082:Renal Veins / Q000502:physiology*; D012772:Shock, Septic / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D013203:Staphylococcal Infections / Q000503:physiopathology; D013815:Thermodilution / Q000295:instrumentation*
D002395:Catecholamines