Renal function and cardiopulmonary bypass in pediatric cardiac surgical patients.
We studied prospectively the perioperative changes of renal function in nine children undergoing cardiac surgery with cardiopulmonary bypass (CPB). Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured with inulin and (131)I-hippuran clearances before CPB, during hypo and normothermic CPB, following sternal closure and 1 h postoperatively. Urinary alpha glutathione S-transferase (alpha GS-T) was measured pre- and postoperatively as a marker for tubular cellular damage. Plasma and urine creatinine and electrolytes were measured. Free water, osmolal and creatinine clearances, as well as fractional excretion of sodium (FeNa) and potassium transtubular gradient (TTKG) were calculated. GFR was normal before and after surgery. ERPF was low before and after surgery; it increased significantly immediately after CPB. Filtration fraction (FF) was abnormally elevated before and after surgery; however, a significant decrease during normothermic CPB and sternal closure was found. Alpha GS-T presented a moderate, but nonsignificant increase postoperatively. FeNa also increased in this period, but not significantly. Creatinine, osmolal, free water clearances, as well as TTKG, were normal in all patients pre- and postoperatively. We conclude that there is no evidence of clinically significant deterioration of renal function in children undergoing repair of cardiac lesions under CPB. Minor increases of alpha GS-T in urine postoperatively did not confirm cellular tubular damage. There was no tubular dysfunction at that time.
Lema
Guillermo
G
Department of Anaesthesiology, Pontificia Universidad Católica de Chile, P.O. Box 114-D, Santiago, Chile. glema@med.puc.cl
Vogel
Andrea
A
Canessa
Roberto
R
Jalil
Roberto
R
Carvajal
Claudia
C
Becker
Pedro
P
Jaque
Maria Paz
MP
Fajardo
Christian
C
Urzua
Jorge
J
D002315:Cardiopulmonary Bypass; D003404:Creatinine / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D005982:Glutathione Transferase / Q000652:urine; D006801:Humans; D007223:Infant; D007444:Inulin / Q000652:urine; D007465:Iodohippuric Acid / Q000378:metabolism; D007527:Isoenzymes / Q000652:urine; D007677:Kidney Function Tests; D007684:Kidney Tubules / Q000473:pathology* / Q000502:physiology*; D008297:Male; D011446:Prospective Studies; D017595:Renal Plasma Flow / Q000502:physiology
D007527:Isoenzymes; D007465:Iodohippuric Acid; D007444:Inulin; D003404:Creatinine; D005982:Glutathione Transferase; C119995:glutathione S-transferase alpha