J Gynecol Oncol.  2009 Mar;20(1):55-59. 10.3802/jgo.2009.20.1.55.

Postoperative acute renal failure in patients with gynecologic malignancies: analysis of 10 cases and review of the literature

Affiliations
  • 1Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. kdyog@amc.seoul.kr

Abstract


OBJECTIVE
Postoperative acute renal failure (PO-ARF) is an important cause of mortality among surgical patients. Although there have been many reports on PO-ARF after cardiac surgery and liver transplantation, less is known about the risk of PO-ARF after gynecologic operations. We aimed to investigate the risk of PO-ARF on gynecologic malignancy operations.
METHODS
1,155 patients' medical charts were reviewed who underwent therapeutic surgery for gynecologic malignancies from January 1, 2005 to December 31, 2007, at the Asan Medical Center, Seoul, Korea.
RESULTS
Of these, 10 patients, comprising 0.89% of those who underwent radical hysterectomies and 0.86% of those who underwent debulking operations, were diagnosed with PO-ARF. Their mean age was 61.9+/-10.1 years. Five patients had preoperative risk factors. Mean operating time was 360.8+/-96.2 minutes. Five patients experienced intra-operative hypotension and all patients were given blood transfusions during surgery. Eight patients underwent hemodialysis, with two continuing on dialysis to date. Only two patients fully recovered.
CONCLUSION
Patients undergoing surgery for gynecologic malignancies may be at high risk for PO-ARF, because of old age, long operation times, and profuse bleeding. It is necessary to monitor these patients for postoperative renal function and urine output. If a postoperative oliguric state is detected, aggressive volume expansion should be started immediately, followed by hemodialysis.

Keyword

Postoperative acute renal failure; Gynecologic malignancy

MeSH Terms

Acute Kidney Injury
Blood Transfusion
Dialysis
Hemorrhage
Humans
Hypotension
Hysterectomy
Korea
Liver Transplantation
Organothiophosphorus Compounds
Renal Dialysis
Risk Factors
Thoracic Surgery
Organothiophosphorus Compounds

Reference

1. Menashe PI, Ross SA, Gottlieb JE. Acquired renal insufficiency in critically ill patients. Crit Care Med. 1998. 16:1106–1109.
2. Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ. French Study Group on Acute Renal Failure. Acute renal failure in intensive care units--causes, outcome, and prognostic factors of hospital mortality. A prospective, multicenter study. Crit Care Med. 1996. 24:192–198.
3. Reddy VG. Prevention of postoperative acute renal failure. J Postgrad Med. 2002. 48:64–70.
4. Miler RD. Anesthesia. 1990. 3rd ed. New York: Churchill Livingstone.
5. Shusterman N, Strom BL, Murray TG, Morrison G, West SL, Maislin G. Risk factors and outcome of hospital-acquired acute renal failure: Clinical epidemiologic study. Am J Med. 1987. 83:65–71.
6. Tilney NL, Lazarus JM. Acute renal failure in surgical patients: causes, clinical patterns, and care. Surg Clin North Am. 1983. 63:357–377.
7. Sladen RN. Oliguria in the ICU: systematic approach to diagnosis and treatment. Anesthesiol Clin North America. 2000. 18:739–752.
8. Sekeroglu MR, Kati I, Noyan T, Dulger H, Yalcinkaya AS. Alterations in the biochemical markers of renal function after sevoflurane anaesthesia. Nephrology. 2005. 10:544–547.
9. Saricaoglu F, Akinci SB, Oc B, Kanbak M, Akbulut B, Celebioglu B. The effect of halothane, isoflurane, sevoflurane and propofol infusion on renal function after coronary artery bypass surgery. Middle East J Anesthesiol. 2006. 18:955–964.
10. Kharasch ED, Frink EJ Jr, Artru A, Michalowski P, Rooke GA, Nogami W. Long-duration low-flow sevoflurane and isoflurane effects on postoperative renal and hepatic function. Anesth Analg. 2001. 93:1511–1520.
11. Harman PK, Kron IL, McLachlan HD, Freedlender AE, Nolan SP. Elevated intra-abdominal pressure and renal function. Ann Surg. 1982. 196:594–597.
12. van Valenberg PL, Hoitsma AJ, Tiggeler RG, Berden JH, van Lier HJ, Koene RA. Mannitol as an indispensable constituent of an intraoperative hydration protocol for the prevention of acute renal failure after renal cadaveric transplantation. Transplantation. 1987. 44:784–788.
13. Shin B, Mackenzie CF, McAslan TC, Helrich M, Cowley RA. Postoperative renal failure in trauma patients. Anesthesiology. 1979. 51:218–221.
14. Dishart MK, Kellum JA. An evaluation of pharmacological strategies for the prevention and treatment of acute renal failure. Drugs. 2000. 59:79–91.
15. Brown RS. Renal dysfunction in the surgical patient: Maintenance of high output state with furosemide. Crit Care Med. 1979. 7:63–68.
16. Lordon RE, Burton JR. Post-traumatic renal failure in military personnel in Southeast Asia: experience at Clark USAF hospital, Republic of the Philippines. Am J Med. 1972. 53:137–147.
Full Text Links
  • JGO
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr