The Diagnosis of Acute Renal Failure (ARF) Following Cardiac Surgery with Cardio-Pulmonary Bypass

Abstract

The diagnostic value of renal concentrating capacity expressed as free water clearance (CH2O), in comparison with other routine criteria for the early identification of acute renal failure (ARF), was evaluated in 1,203 adult patients undergoing cardiac surgical procedures. On the basis of the appearance of pathologic CH2O values in the range of -20 to 0 ml/hour or more positive, reversible or irreversible ARF was observed in 90 (= 7.5%) of our patients. Mortality in the presence of ARF was 47%; total ARF mortality was 3.5%. CH2O was pathologic for the first time on an average of 1.6 days after operation. In contrast, routine ARF criteria reported in the literature, such as serum urea and creatinine at varying substrate levels or oliguria, allowed diagnosis 1 to 5.5 days later. Moreover, these parameters only partially and less frequently met the criteria for ARF at the different levels. Likewise, the incidence of ARF decreased to a minimum of 1.7% and the total ARF mortality to 1.3%, depending on the severity of the criteria used. Altogether, the occurrence of pathologic CH2O values proved to be the earliest, most frequent and most reliable criterion for the recognition of ARF following cardiac surgery with cardiac-pulmonary bypass.

Detection of evolving acute tubular necrosis with renal 23Na MRI: Studies in rats

“…A loss of urinary concentrating capacity is an early indicator of ATN, reflecting altered countercurrent system and urine concentration capacity. [4][5][6][7][8] Non-invasive detection of the corticomedullary sodium gradient may, therefore, serve as an early real-time indicator of evolving ATN. Herein we show that the renal sodium MR images revealed a marked change in the corticomedullary sodium signal intensity profile during the early evolution of ATN.…”

“…Indeed, a declining urinary osmolarity, a hallmark of a disrupted concentrating system, is considered a very early sign of evolving ATN. [4][5][6][7][8] Clinical identification of early-stage ATN and its differentiation from other causes of acute renal failure are currently limited. The diagnosis of ATN is often done at an advanced, established phase, beyond the time-point of potential preventive intervention.…”

133. Postoperatives Nierenversagen: Prophylaxe und Therapie

“…Oligoanurie ist jedoch nicht obligat, mindestens 1/3 der F~ille verlfiuft nicht-oligurisch (Harnausscheidung tiber 600 ml/die) oder primfir polyurisch (Harnausscheidung fiber 1000 ml/24 h, tiber 45 ml/h) [2]. Die Friihphase des akuten Nierenversagens ist gekennzeichnet durch ein Absinken der Harnosmolalitfit unter 400 mosm/1 mit einer Annfiherung des osmotischen Harnplasmaquotienten U/Pos m gegen 1,0 sowie einem Absinken der Freiwasserclearance a unter -20 ml/h und Annfiherung der Werte gegen Null [3,19,21,27,32].…”

“…Die besondere Bedeutung der osmolaren Parameter liegt in ihrer Aussagekraft zur Frtihdiagnose des akuten Nierenversagens [3,19,27]. Holper und Mitarb.…”