Can renal dysfunction after infra-renal aortic aneurysm repair be modified by multi-antioxidant supplementation?
BACKGROUND
Renal failure after lower torso ischemia is a serious problem, partly caused by hypotension and indirect reperfusion injury. This injury is partly due to the formation of oxygen free radicals by activated neutrophils. This injury results in albuminuria and renal function impairment. There are indications that free radical damage in indirect reperfusion injury can be diminished by administering extra antioxidants before and during reperfusion.


METHODS
In this prospective randomised study we have looked at the influence of a multi-antioxidant supplementation on renal function in patients undergoing an elective open infrarenal abdominal aneurysm repair. The patients received either standard treatment (n=22) or standard treatment with additional antioxidants perioperatively (Allopurinol, vitamin E and C, N-acetylcysteine and mannitol). For renal function we have looked at the albumin/creatinine ratio in urine and 24 hr creatinine clearance.


RESULTS
Despite significantly increased serum total antioxidant capacity, the group receiving extra antioxidants showed no decrease in the albumin/creatinine ratio in urine. There was however a significantly higher creatinine clearance in this group at day 2.


CONCLUSIONS
The results indicate that the diminished renal function after infrarenal aneurysm repair may be influenced by antioxidant therapy.
Department of Surgery, Saint Joseph Hospital, Veldhoven, The Netherlands. mhwijnen@worldonline.nl
M H W A
MH
Wijnen
H L
HL
Vader
A W L
AW
Van Den Wall Bake
R M H
RM
Roumen
D000111:Acetylcysteine / Q000627:therapeutic use; D000368:Aged; D000419:Albuminuria / Q000517:prevention & control; D000493:Allopurinol / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001205:Ascorbic Acid / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008353:Mannitol / Q000627:therapeutic use; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000188:drug therapy* / Q000503:physiopathology; D015427:Reperfusion Injury / Q000188:drug therapy* / Q000503:physiopathology; D014810:Vitamin E / Q000627:therapeutic use
D000975:Antioxidants; D014810:Vitamin E; D008353:Mannitol; D000493:Allopurinol; D001205:Ascorbic Acid; D000111:Acetylcysteine