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[Kidney function in test subjects: published results and clinical relevance].

Sevoflurane degrades in CO2 absorbents to produce compound A, which may have hepatotoxic potential in humans. Several recent studies in human volunteers have been performed to evaluate this potential. Three studies have evaluated sevoflurane administered to volunteers using a 3% concentration for 8 h duration at approximately 2 L/min flow rate. The initial investigation found high excretion of protein, glucose and renal tubular enzymes in the urine of the volunteers receiving sevoflurane. Subsequent investigations using identical protocols found more minor or absent changes in excretion of these markers. One additional investigation in volunteers studied 3% sevoflurane anesthesia for 4 h duration using a low-flow (1 L/min) technique. No significant excretion of protein, glucose or renal enzymes was observed. Application of these results to clinical practice must be interpreted in light of the experimental nature of the anesthetic administration. Although some controversy remains, these data, combined with results of recent studies in surgical patients, suggest that renal function following modest duration low-flow sevoflurane anesthesia is similar to that following isoflurane anesthesia.

Anesthetics, Inhalation↗

[Monitoring kidney function during neonatal intensive care: comparison between Doppler ultrasound findings and renal function parameters].

33 neonates between 4th and 7th day of life were enrolled in the study. The data of renal Doppler sonography were compared to renal excretion parameters. In infants with respiratory distress a decrease of creatinine clearance as well as an increase of fractional sodium excretion were associated with reduced peak systolic flow velocity in the A. renalis. The results suggest the importance of the Doppler sonography in the monitoring of the renal function in the newborn intensive care.

Blood Flow Velocity↗

[Osmolarity parameter and kidney function of polytraumatized intensive care patients].

Improved possibilities in prediction of renal failure after polytrauma would possibly improve the survival rate of this severe posttraumatic complication. Our clinical investigation was carried out in 27 patients suffering from severe trauma. We intended to achieve early recognition of acute renal failure by osmolality measurements after polytrauma. Thus we investigated the daily concentration of blood urea, serum and urine creatinine, daily urine output, creatinine clearance, plasma and urine osmolality and the serum colloid osmotic pressure. Additional to important informations for fluid and electrolyte replacement the follow-up of osmolality changes in plasma and urine proved general and renal prognostic value. Early and clear decreases in urine-plasma ration, osmolar clearance and negative free water clearance were found in case of later reduction of renal function and acute renal failure. Consequently we advise regular osmolality measurements in the postoperative management of the polytraumatic patient.

Acute Kidney Injury↗

Periarterial papaverine application improves intraoperative kidney function during laparoscopic donor nephrectomy.

BACKGROUND: Laparoscopic donor nephrectomy decreases disincentives to donation frequently associated with the disadvantages of open surgery. However, concerns have been raised regarding graft quality, since the incidence of delayed graft function is higher when compared with open procedures. This may be caused by amelioration of kidney perfusion due to the elevated intraabdominal pressure and to a mechanically induced renal angiospasm during donation. This study was addressed to reveal whether the renal periarterial application of papaverine is able to enhance renal blood flow during laparoscopic nephrectomy. MATERIALS AND METHODS: Twelve male piglets underwent left laparoscopic donor nephrectomy after endoscopic occlusion of the right renal vessels and ureter. Urine output and creatinine clearance were determined as indicators of renal blood flow. In the treatment group (n = 6) papaverine hydrochloride was administered to the tissue surrounding the renal artery prior to preparation of the vessels and results were compared with those of controls (n = 6). Free sodium excretion was measured to preclude prerenal failure. RESULTS: In the control group the mean urine output was 0.015 ml/min/kg and the mean creatinine clearance was 0.95 ml/min/kg. In pigs treated with papaverine the mean urine output was 0.052 ml/min/kg and the mean creatinine clearance was 2.22 ml/min/kg. The differences were significant (urine output, P = 0.02; creatinine clearance, P = 0.038). CONCLUSIONS: Papaverine improves renal function during laparoscopic kidney harvest when applied in the vicinity of the renal artery prior to vascular preparation.

Animals↗

[Clinical kidney function studies in sheep. III. Pathologic function changes in nephropathies of sheep and in urolithiasis of rams and billy goats].

Examination of renal function have been carried out in sheep with acute prerenal (n = 6), renal (n = 15) or postrenal failure (n = 3), pyelocystitis (n = 4), and in cases of urolithiasis in rams (n = 16) and billy goats (n = 11) respectively. The calculation of parameters was done on the basis of the estimated weight dependent endogenous creatinine excretion. A control group of 56 healthy non pregnant or early pregnant (< 120th day of pregnancy) ewes have been used. The renal creatinine clearance was reduced and the absolute as well as the fractional renal water excretion was enhanced in all groups of sick animals. An elevated fractional excretion of sodium and phosphate could be seen as well. Functional disturbances could be observed in urolithiasis in like manner as in acute renal failure. There was proteinuria, glucosuria, excessive potassium excretion and often decreased plasma concentration of potassium in both syndromes. A hyperkalemia occurred only in the final state of urolithiasis. No clinical outcome of chronic nephropathies could be seen. Mortality of the described acute nephropathies was about 76%. The results of examination were suitable to control the course and restitution of renal function. They were not helpful for differential diagnosis and prognosis of acute renal failure.

Animals↗