Abstract
ARF is an important complication of cardiac surgery in Infants. Nineteen, aged 2 d.-12 mo., of 183 operated on developed ARF(9%). The defects were transposition 5.VSD 5, interrupted aorta 4, PDA 2, A-V canal 1, pulmonary atresia 1 and single ventricle 1. Ten underwent open heart surgery.
Preoperatively 4 were oliguric. Postoperatively 13 were anuric 1-13 days and 5 oliguric 1-5 days;1 had polyuric renal failure. All had elevated BUN and serum creatinines. Serum K was >6.7 mEq/L in 17, Ca <7.5 mg% in 10, blood glucose <30 mg% in 9 and 9 had metabolic acidosis. Although heart failure was present in all, ARF appeared to be due to intrinsic renal failure in each patient. The causes identified were:hypotension(14), hypertonic angiocath dye shortly before surgery(7),aminoglycosides(19), dysplastic kidneys(1)and tamponade(3). Fluid and electrolyte management problems were difficult but critical. Insulin could not be given to reduce hyperkalemia in hypoglycemic infants. Furosemide up to 10 mg/kg did not induce diuresis. Only 2 of 13 with anuria survived; 13/14 with hypotension died and all normotensive infants survived, Hypotension was identified as the most important factor in the pathogenesis and prognosis of ARF.
This study is the first to examine in detail ARF as an important complication of cardiac surgery in infants.
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Chesney, R., Kaplan, B., Drummond, K. et al. ACUTE RENAL FAILURE(ARF) ASSOCIATED WITH CARDIAC SURGERY IN INFANCY. Pediatr Res 8, 348 (1974). https://doi.org/10.1203/00006450-197404000-00046
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DOI: https://doi.org/10.1203/00006450-197404000-00046