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Renal impairment in hepatic cryotherapy
J S Bagia1, D S Perera, D L Morris
1Department of Surgery, University of New South Wales, St. George Hospital, Kogarah, Sydney, Australia.
Cryobiology
|July 9, 1998
Summary
Hepatic cryotherapy can cause kidney damage, especially with larger or more numerous liver tumors treated. Extensive cryotherapy, indicated by higher AST levels, predicts a greater risk of renal impairment.
Area of Science:
- Nephrology
- Hepatology
- Oncology
Background:
- Cryoshock, a syndrome of coagulopathy and organ injury post-cryotherapy, has an unknown etiology.
- Hepatic cryotherapy is used for primary or secondary hepatic malignancies.
Purpose of the Study:
- To assess hepatic cryotherapy's impact on renal function.
- To determine if cryotherapy volume predicts renal impairment.
- To identify predictors of renal impairment after hepatic cryotherapy.
Main Methods:
- Retrospective analysis of 204 patients with hepatic malignancy treated with cryotherapy (April 1990 - October 1996).
- Renal impairment defined as creatinine elevation >0.02 mmol/L for >2 days post-procedure.
- Comparison of demographic data, lesion characteristics, and liver injury markers between patients with and without renal impairment.
Main Results:
- Ten patients (4.9%) experienced renal impairment, usually modest (mean creatinine rise 0.31 mmol/L).
- Two patients required temporary hemodialysis; one experienced pulmonary injury and shock.
- Renal impairment was associated with a higher number and diameter of lesions, increased freezing time, and higher AST levels (all P < 0.01).
Conclusions:
- Extensive hepatic cryotherapy, indicated by more/larger lesions and higher AST, is linked to increased risk of renal impairment.
- The magnitude of liver injury correlates with renal injury severity.
- Further research is needed to elucidate the exact etiology of cryoshock.