الفهرس 
PATHOPHYSIOLOGY OFOnly 14 pages are availabe for public view
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Abstract
A
cute renal failure (ARF) occurs in up to 30% of patients who undergo cardiac surgery, with dialysis being required in approximately 1% of all patients. The development of kidney injury is associated with a high mortality, a more complicated hospital course, and a higher risk for infectious complications .Even minimal changes in serum creatinine that occur in the postoperative period are associated with a substantial decrease in survival. Furthermore, the majority of patients who develop ARF that requires dialysis (ARF-D) remain dialysis dependent, leading to significant long-term morbidity and mortality.
The precise etiology of CPB-associated ARF is not known. The byproducts of traumatic intravascular hemolysis, such as free hemoglobin, may be possible contributors to the development of ARF. Free hemoglobin may precipitate within the tubular lumen causing obstruction; directly injured renal epithelial cells through iron-catalyzed free radical oxidation of cellular membranes; and induce renal vasoconstriction, providing a major pathway for the induction of post-CPB ARF.
This study evaluates the influence of free hemoglobin generation during CPB and the capacity to sequester free iron indicated by levels of preoperative serum ferritin levels on the occurrence of post-CPB renal insufficiency and the modification of this effect by the use of hemofiltration at the end of cardiopulmonary bypass.
Eighty Patients of both sexes were included, with normal kidney functions, undergoing elective first-time CABG and using CPB, evaluating serum ferritin levels as indicator of post operative renal impairment. And the combined effect of use of hemofiltration at the end of cardiopulmonary bypass on renal function. Serum creatinine was taken as indicator of filtration function of the glomeruli. ARF was defined as a 25% or greater increase in creatinine level 48 hours after surgery.
Serum ferritin, creatinine, electrolytes, and albumin levels, was measured on the morning of surgery (before induction of anesthesia) and 48 hours after surgery.