Introduction. Renal disease plays an important role in the prognosis and evolution of chronic liver disease, in particular in its advanced stages. The aim of our study is to analyze the prevalence of chronic liver disease (hepatitis and cirrhosis of different etiologies) and to assess possible correlations between these and impaired renal function. Material and methods. We conducted a retrospective observational study based on data collected from observation charts of patients admitted to the 2nd Medical Clinic, Emergency County Hospital Tirgu-Mures between January 1st 2012-December 31 2013. In this study we included, based on informed consent, 401 patients with documented liver pathology, with preserved or modified renal function. Results. Age distribution shows that 41.1% of cases occured between 51 and 60 years of age. Sex distribution shows that 65.3% of cases were male. Toxic cirrhosis was found in 40.8% of males and viral C cirrhosis in 15.1% of women. Toxic cirrhosis associated the following complications: ascites (35.7%), encephalopathy (75%), PAH (68.6%), esophageal varices and upper GI bleed (35.7%). Analyzing the risk factors of renal failure we found that increased mean values of creatinine are associated with viral B cirrhosis (p = 0.02), portal vein diameter (OR 1.37), portal hypertension (OR 1.24), male gender (OR 1.84) and the age group 61-70 yo (OR 1.04). Conclusions. The current study demonstrated that renal function in chronic liver disease correlates with viral etiology of liver disease, its advanced stage, presence of portal hypertension, older age and male gender.
Background: Renal dysfunction is one of the most common complications after cardiac surgery. The major concern is that despite advances in bypass techniques, intensive care and delivery of hemodialysis, mortality and morbidity associated with renal failure have not markedly changed in the last decade. The purpose of this work was to study the incidence of renal dysfunction after cardiac surgery, analyzing the possible causes, associated risk factors and treatment methods used.
Material and methods: In this prospective observational study we analyzed patients undergoing open-heart surgery between October 1, 2010 – December 15, 2010 at the Clinic of Cardiac Surgery Târgu Mureș. Blood urea nitrogen and creatinine level were recorded for all patients before and after surgery, patients age, sex, type of surgical intervention, length of cardiopulmonary bypass, and the degree of intraoperative hypothermia, hemodilution and postoperative hemodynamic function were noted.
Results: In this period 89 patients underwent cardiac surgery. Renal dysfunction developed in 20.2% of the patients and was more common in patients with complex surgery with prolonged cardiopulmonary bypass (p<0.0167), in patients with intraoperative hemodynamic instability. Other intraoperative factors, such as hemoglobin level lower than 8 g/dl (p=0.0103), postoperative hemodynamic dysfunction and use of vasoconstrictor agents also influenced the development of renal dysfunction.
Conclusions. Cardiac surgery is associated with a relative high incidence of renal dysfunction. Risk factors for this syndrome are varied and involve hemodynamic and inflammatory changes, but factors such as the body temperature and hemoglobin level during extracorporeal circulation could have a significant contribution.
Introduction: The widespread use of sevoflurane as an induction and maintenance volatile agent of general anesthesia demostrates an increased safety profile. Sevoflurane contact with CO2 absorbents lead to the occurrence of toxic compounds such as Compund A and Compound B . Among the side efffects of Sevoflurane remember the renal toxic effect much discussed in the literature but still unresolved. In previous research we have demonstrated the glomerular protein changes as a result of exposure to Sevoflurane. In the current study we intend to monitor the changes in blood urea nitrogen and serum creatinine after exposure to Sevoflurane.
Material and method: We included in our study 90 patients who were anesthetized in the Department of Anesthesiology of the County Mure Hospital during 01.10.2009-01.10.2014. They had normal values for blood urea nitrogen and serum creatinine and had no preoperative proteinuria. Serum and urine samples were taken preoperatively and at 24 and 72 hours postanesthetic and were analyzed in the laboratory. Proteinuria was determined by spectrophotometry.
Results: After protein quantitative determination by spectrophotometry and statistical anaysis we obtained significant differences by comparing the average preoperative/24 hours total protein (p<0.0001) and 24/72 hours (p<0.0001). There are no significant statistical differences by comparing the blood urea nitrogen at the three intervals (p<0.53) and no statistical changes for mean serum creatinine (p<0.18).
Conclusions: Changes in glomerular filtered proteins following exposure to Sevoflurane demonstrate its toxic effect on glomerular tubules. Lack of perioperative significant wich is why we recommend determining perioperative urinary protein as a marker of glomerular damage.