Renal failure associated with unrecognized hyperoncotic states after pediatric heart surgery

Despite severe alteration of transcapillary fluid exchange during cardiopulmonary bypass, colloid osmotic pressure is not routinely assessed. Infusion therapy during pediatric heart surgery is determined by clinical parameters and on the basis of total plasma protein level alone. Following this concept, postoperative renal dysfunction associated with unrecognized hyperoncotic disturbances has been observed in two children. Hyperoncotic states may not be identified by routine laboratory parameters.