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Enflurane nephrotoxicity and pre-existing renal dysfunction

M J Cousins, A Fulton, W David

    Anaesthesia and Intensive Care
    |November 1, 1978
    PubMed
    Summary
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    High enflurane doses cause kidney damage, especially with pre-existing renal impairment. Combining gentamicin and enflurane anesthesia significantly increased fluoride levels and kidney cell damage in rats.

    Area of Science:

    • Anesthesiology
    • Nephrology
    • Toxicology

    Background:

    • High doses of enflurane anesthesia can cause renal functional abnormalities.
    • Enflurane's potential for renal toxicity may be exacerbated by existing kidney impairment.

    Purpose of the Study:

    • To investigate the morphological evidence of structural damage from high-dose enflurane.
    • To confirm renal functional abnormalities following high-dose enflurane.
    • To assess enflurane's renal toxicity in the context of prior renal impairment.

    Main Methods:

    • Fischer 344 rats were treated with a nephrotoxic dose of gentamicin.
    • Animals underwent six hours of enflurane anesthesia at 1 MAC.
    • Serum inorganic fluoride levels, urine flow rate, and renal proximal convoluted tubule cell damage were measured.

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    Main Results:

    • Combined gentamicin and enflurane (GE) treatment showed higher serum inorganic fluoride (43.9 +/- 1.5 mu mol/L) compared to enflurane alone (E, 34.5 +/- 1.8 mu mol/L).
    • GE group exhibited increased urine flow rate and greater structural damage in renal proximal convoluted tubule cells than G or E alone.
    • Urinary osmolality was reduced in the GE group (742 +/- 57 m0sm/kg) compared to E (1709 +/- 66 m0sm/kg) or G (985 +/- 32 m0sm/kg) alone.

    Conclusions:

    • High doses of enflurane alone cause significant structural kidney damage.
    • Enflurane anesthesia potentiates renal toxicity when renal impairment is present.
    • The combination of gentamicin and enflurane leads to increased fluoride levels and severe renal damage.