Renal Insufficiency After Cardiac Surgery

Abstract

The new millennium ushered in a number of changes in cardiac surgery. Off-pump coronary artery bypass surgery became technically easier so that multivessel surgery became less of a challenge and cardiologists were supplied with new catheters that accessed lesions that were previously thought of as being unapproachable. New drugs were introduced that made the management of heart failure patients feasible on an outpatient basis, and new devices extend the bridging period to transplantation. However, these advances have not necessarily been attended by significant improvements in outcome, possibly because the less challenging a procedure becomes, the sicker the patients that can be managed. This observation is particularly true with the incidence and outcome of renal failure after cardiac surgery. Bypass factors have been manipulated without much effect, and the traditional drugs that were found to increase renal blood flow in animal experiments did not translate into clinical improvement in renal outcome. Recent research has given us insight into the pathophysiology of ischemic acute renal failure, and it has been found that the paradigm was not as simple as previously thought, possibly accounting for the failure of the more traditional renal drugs (dopamine, mannitol and diuretics). However, these new insights open up the possibility of novel targets for renal protection and repair.

Prevention of Acute Kidney Injury by Erythropoietin in Patients Undergoing Coronary Artery Bypass Grafting: A Pilot Study

“…Potential causes include cardiovascular compromise, prolonged cardiopulmonary bypass (CPB) exposure, increased catecholamine levels, atheroembolism, hypothermia, decreased renal perfusion, reperfusion injury, exposure to nephrotoxic agents, and inflammation [9]. There have been many clinical attempts to prevent or treat AKI after cardiac surgery.…”

Complicações que aumentam o tempo de permanência na unidade de terapia intensiva na cirurgia cardíaca

“…Because of hemodynamic instability that can happen in the immediate postoperative period, the patient may need inotropic support (VAD) and must remain in the Intensive Care Unit (ICU) while there is need [15][16][17]. The controls of vital data, such as capillary blood glycemia and monitoring are performed on an hourly basis, which can also bring discomfort to the patient [2,[18][19][20][21].…”

The effect of sodium nitroprusside infusion on renal function during reperfusion period in patients undergoing coronary artery bypass grafting: a prospective randomized clinical trial

“…The sources of renal insult are: decreased renal perfusion, reperfusion injury, inflammatory response, vasoconstriction from circulating vasoconstrictors, atheroembolism, loss of pulsatility during cardiopulmonary bypass (CPB) or exposure to nephrotoxic agents [6]. Thus, high-risk patient population for ARF may be targeted for perioperative interventions that may reduce the risk or ameliorate the outcome [6].…”