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Acute renal failure following pulmonary surgery
J D Urschel1, J G Antkowiak, H Takita
1Division of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York 14263-0001.
Objective:
To determine incidence, predisposing factors, and outcome of acute renal failure complicating pulmonary surgery.
Design:
Retrospective review.
Setting:
Tertiary cancer hospital.
Patients:
Patients undergoing pulmonary resection over a 25-year period.
Measures:
Morbidity and mortality of postoperative acute renal failure.
Results:
Six of 1595 (0.4%) patients developed acute renal failure. All 6 patients had advanced thoracic malignancies that required extensive resections. No patient undergoing simple lobectomy, or lesser pulmonary resection, developed acute renal failure. Sepsis and respiratory failure were present in all 6 patients prior to onset of acute renal failure. All patients died of multiple organ failure.
Conclusions:
The incidence of acute renal failure following pulmonary surgery is very low. Management strategies developed for other surgical patients may not be appropriate in the setting of pulmonary surgery. Specific perioperative preventive measures, such as intravenous fluid loading, are not warranted and may be harmful. Acute renal failure after pulmonary surgery has a very high mortality. Associated post-operative complications, such as sepsis and respiratory failure. are largely responsible for this high mortality. Treatment of acute renal failure in pulmonary surgery patients consists of maintenance of tissue oxygenation, elimination of sepsis, nutritional support, and dialysis or hemofiltration.