Prevention of Acute Renal Failure after Aortic Surgery

Graziani, G.; Carabellese, G; Lorenzano, Elettra; Costantini, Andrea; Casati, Stefano; Crepaldi, Maria Aparecida; Benigni, Ariela; Zanetta, M.; Morganti, Alberto; Agrifoglio, G

doi:10.1159/000416916

Cited by 2 publications

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“…A reduced ET seer tion is, however, insufficient to explain the effect of infusion, which independent of ET levels raises creatinii clearance during the clamp period. Clearly, ET is not tl only mediator known to increase during ICC as both Txl and renin are elevated and are both capable of inducii renal vasoconstriction and reducing GFR [11], In add tion, it is known that intrarenal infusion of ET increas' prostanoid synthesis [26]. In fact, our results indicate that higher plasma levels of ET during the clamp period both groups paralleled the increased renal synthesis < PGE2, 6-keto PGF|a and TxB^.…”

Section: Discussionmentioning

confidence: 52%

“…The goals of this study were several: (1) to confirm the efficacy of nifedipine in a larger number of patients undergoing ICC; (2) to compare the effect of a calcium entry blocker to that of low-dose dopamine, and (3) to obtain more information about the possible mechanism of nifedipine action. With respect to the mechanisms responsible, we concentrated on endothelin (ET) [10], renin and thromboxane IT (TxIT) [11] as these have been advanced as possible modulators of the renal vasocon striction observed after ICC. While calcium entry block ers have no effect on renin secretion [12], little informa tion is available regarding their effect on prostanoids syn thesis and endothelin production.…”

Section: Introductionmentioning

confidence: 99%

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Nifedipine Can Preserve Renal Function in Patients Undergoing Aortic Surgery with Infrarenal Crossclamping

Antonucci¹,

Calò²,

Rizzolo³

et al. 1996

Nephron

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Sixteen patients diagnosed with an aneurysm of abdominal aorta or Leriche disease underwent elective aortic surgery involving crossclamping of infrarenal aorta (ICC). These patients were randomized into two equal groups and 8 patients were infused with nifedipine starting from the isolation of aorta until the end of surgery (group A) while another 8 patients were infused with low-dose dopamine (group B) over the same surgical course. Plasma endothelin (ET) was measured before the induction of anesthesia, at the beginning and at the end of the clamp period and at the end of the operation. Intraoperatively, creatinine clearance and urinary excretion of PGE₂, 6-keto PGF_1α and TxB₂ were also determined before, during and after aortic crossclamping. Pre-operative GFR as well as preinduction cardiac index (CI) and pulmonary capillary wedge pressure (PCWP) of the two groups did not differ. During crossclamping plasma ET rose significantly in both groups. However, after clamp removal, plasma ET decreased in group A while it remained elevated in group B. Urinary excretion of TxB₂, PGE₂ and 6-keto PGF_1α increased during clamp in both groups, but the ratio of PGE2 + 6-keto PGF_1α/TxB₂ during and after clamp was significantly higher in group A than in B. Postclamp creatinine clearance decreased in group B, and increased in group A; postoperative value of GFR was unchanged in group A and decreased significantly in group B. In conclusion, infusion of nifedipine, in contrast to dopamine, prevented the decrease of GFR in patients undergoing aortic surgery. This effect could be mediated by a nifedipine modulation of ET vascular synthesis and/or a preferential renal synthesis of vasodilating prostanoids.

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Section: Discussionmentioning

confidence: 52%