Randomized clinical trial of the effects of methylprednisolone on renal function after major vascular surgery.
BACKGROUND
Perioperative renal dysfunction following abdominal aortic aneurysm (AAA) repair is multifactorial and may involve hypotension, hypoxia and ischaemia-reperfusion injury. Studies of cardiac and hepatic transplant surgery have demonstrated beneficial effects on renal function of high-dose methylprednisolone administered before surgery.


METHODS
Twenty patients undergoing elective open AAA repair were randomized to receive either methylprednisolone 10 mg/kg or dextrose (control) before induction of anaesthesia. Blood was analysed for a panel of cytokines representative of T helper cell type 1 and 2 subsets. Urine was analysed for subclinical markers of renal dysfunction (albumin, alpha(1)-microglobulin and N-acetyl-beta-D-glucosaminidase).


RESULTS
Data from 18 patients were analysed. Both groups demonstrated glomerular and proximal convoluted tubular dysfunction that was unaffected by steroid treatment. Steroid administration increased serum levels of urea and creatinine (both P < 0.001). The steroid group had increased interleukin 10 levels (P = 0.005 compared to controls). There were no differences between groups in overall surgical complications, length of intensive care unit (P = 0.821) and hospital (P = 0.719) stay, or 30-day mortality.


CONCLUSIONS
Methylprednisolone administration altered the cytokine profile favourably but adversely affected postoperative renal function.
Turner
S
S
Academic Unit of Anaesthesia, Leeds General Infirmary, Leeds, UK.
Derham
C
C
Orsi
N M
NM
Bosomworth
M
M
Bellamy
M C
MC
Howell
S J
SJ
D000118:Acetylglucosaminidase / Q000652:urine; D000368:Aged; D000419:Albuminuria / Q000209:etiology; D000510:Alpha-Globulins / Q000652:urine; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D003250:Constriction; D016207:Cytokines / Q000378:metabolism; D004311:Double-Blind Method; D006801:Humans; D007674:Kidney Diseases / Q000517:prevention & control* / Q000652:urine; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D012086:Reoperation; D006377:T-Lymphocytes, Helper-Inducer / Q000187:drug effects / Q000378:metabolism
D000510:Alpha-Globulins; D000893:Anti-Inflammatory Agents; D016207:Cytokines; C016001:alpha-1-microglobulin; D000118:Acetylglucosaminidase; D008775:Methylprednisolone