title: The role of pharmacological steroid therapy in preservation of renal function in severely injured patients requiring massive transfusion.
abstract: OBJECTIVE
  Glucocorticoids (GC) attenuate the post-insult inflammatory response and have been observed to confer end-organ protection following a variety of ischemic insults. We aim to assess this benefit on renal perfusion and function in injured patients requiring massive transfusion.
  
  
  METHODS
  The effect of pharmacologic methylprednisolone (MP) therapy was studied in 118 patients (pts), of whom 60, by random, received 1 g MP intraoperatively and 15 mg/kg for an additional 3 days. Postoperative measurements were made of effective renal plasma flow (ERPF), glomerular filtration by inulin (CIn), creatinine clearance (CCr) and clearances of osmoles (CCosm), sodium (CNa), and free water ([Formula: see text]). Continuous variables were compared between the two groups using the student's t test.
  
  
  RESULTS
  Enrolled pts on average received 13.5 units of PRBCs with no differences in the resuscitation regimen. There were no statistically significant differences in the postoperative renal function as measured by ERPF (p = 0.57), CIn (p = 0.84), CCr (p = 0.99), CNa (p = 0.07), COsm (p = 0.95), and [Formula: see text] (p = 0.33). The incidence of renal compromise, as determined by an inulin clearance of <25 mL/min or serum creatinine greater than 3.0 mg/dL, was also similar. Three patients in the MP treatment group had renal compromise compared to one in the control group.
  
  
  CONCLUSIONS
  In the absence of larger studies, this study demonstrates that GC likely have no role in preserving renal function in severely injured patients.
authors.affiliation: Department of Surgery, Wayne State University/Detroit Medical Center, Room 2V, 540 E. Canfield Avenue, Detroit, MI, 48201, USA.
authors.forename: F A
authors.initials: FA
authors.lastname: Khan
authors.affiliation: Department of Surgery, Wayne State University/Detroit Medical Center, Room 2V, 540 E. Canfield Avenue, Detroit, MI, 48201, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Ledgerwood
authors.affiliation: Department of Surgery, Wayne State University/Detroit Medical Center, Room 2V, 540 E. Canfield Avenue, Detroit, MI, 48201, USA. clucas@med.wayne.edu.
authors.forename: C E
authors.initials: CE
authors.lastname: Lucas
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D016913:Blood Component Transfusion; D005260:Female; D005919:Glomerular Filtration Rate; D005938:Glucocorticoids / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000502:physiology / Q000503:physiopathology; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D009104:Multiple Trauma / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D012771:Shock, Hemorrhagic / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D014481:United States; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D008775:Methylprednisolone
keywords: Glucocorticoids; Massive transfusion; Pharmacological steroids; Renal failure; Renal perfusion; Traumatic injury