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Renal Failure After Ruptured Aneurysm

Renal Failure After Ruptured Aneurysm Abstract The effectiveness of an intravenous nutritional program plus aggressive dialysis was studied in 32 patients with renal failure following ruptured abdominal aortic aneurysm. Each patient was managed postoperatively with a renal failure fluid regimen, consisting of the eight essential amino acids plus dextrose in conjunction with peritoneal dialysis and hemodialysis. This regimen induced salutary metabolic effects temporarily improving the patient's condition in most instances. No technical or septic complications associated with the intravenous dietary therapy occurred. However, the incidence of recovery of renal function was low, and the overall patient survival was only 12.5%. The experience indicates that although this program has been shown to be efficacious in some patients with acute renal failure, it seems of little benefit in those whose renal failure follows ruptured aortic aneurysm. References 1. Stott RB, Cameron JS, Ogg CS, et al: Why the persistently high mortality in acute renal failure? Lancet 2:75-79, 1972.Crossref 2. Giordano C: Use of exogenous and endogenous urea for protein synthesis in normal and uremic subjects . J Lab Clin Med 62:231-246, 1963. 3. Giovannetti S, Maggiore Q: A low-nitrogen diet with proteins of high biological value for severe chronic uraemia . Lancet 1:1000-1003, 1964.Crossref 4. Abel RM, Beck CH Jr, Abbott WM, et al: Improved survival from acute renal failure after treatment with intravenous essential l-amino acids and glucose . N Engl J Med 288:695-699, 1973.Crossref 5. Abel RM, Abbott WM, Fischer JE: Intravenous essential l-amino acids and hypertonic dextrose in patients with acute renal failure . Am J Surg 123:632-638, 1972.Crossref 6. Abbott WM, Abel RM, Fischer JE: Treatment of acute renal insufficiency after aortoiliac surgery . Arch Surg 103:590-594, 1971.Crossref 7. Abel RM, Abbott WM, Fischer JE: Acute renal failure: Treatment without dialysis by total parenteral nutrition . Arch Surg 103:513-514, 1971.Crossref 8. Darling RC: Ruptured arteriosclerotic abdominal aortic aneurysms . Am J Surg 119:397-401, 1970.Crossref 9. Ryan JA Jr, Abel RM, Abbott WM, et al: Catheter complications in total parenteral nutrition: A prospective study of 200 consecutive patients . N Engl J Med 290:757-761, 1974.Crossref 10. Tilney NL, Bailey GL, Morgan AP: Sequential system failure after rupture of abdominal aortic aneurysms: An unsolved problem in postoperative care . Ann Surg 178:117-122, 1973.Crossref 11. Baker AG Jr, Roberts B, Berkowitz HD, et al: Risk of excision of abdominal aortic aneurysms . Surgery 68:1129-1134, 1970. 12. Thompson JE, Vollman RW, Austin DJ, et al: Prevention of hypotensive and renal complications of aortic surgery using balanced salt solution: Thirteen-year experience with 670 cases . Ann Surg 167:767-778, 1968.Crossref 13. Powers SR Jr, Boba A, Hostnik W, et al: Prevention of postoperative acute renal failure with mannitol in 100 cases . Surgery 55:15-23, 1964. 14. Barry KG, Malloy JP: Oliguric renal failure, evaluation and therapy by the intravenous infusion of mannitol . JAMA 179:134-137, 1962.Crossref 15. Abbott WM, Austen WG: The reversal of renal cortical ischemia during aortic occlusion by mannitol . J Surg Res 16:482-489, 1974.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1975 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1975.01360150054010
Publisher site
See Article on Publisher Site

Abstract

Abstract The effectiveness of an intravenous nutritional program plus aggressive dialysis was studied in 32 patients with renal failure following ruptured abdominal aortic aneurysm. Each patient was managed postoperatively with a renal failure fluid regimen, consisting of the eight essential amino acids plus dextrose in conjunction with peritoneal dialysis and hemodialysis. This regimen induced salutary metabolic effects temporarily improving the patient's condition in most instances. No technical or septic complications associated with the intravenous dietary therapy occurred. However, the incidence of recovery of renal function was low, and the overall patient survival was only 12.5%. The experience indicates that although this program has been shown to be efficacious in some patients with acute renal failure, it seems of little benefit in those whose renal failure follows ruptured aortic aneurysm. References 1. Stott RB, Cameron JS, Ogg CS, et al: Why the persistently high mortality in acute renal failure? Lancet 2:75-79, 1972.Crossref 2. Giordano C: Use of exogenous and endogenous urea for protein synthesis in normal and uremic subjects . J Lab Clin Med 62:231-246, 1963. 3. Giovannetti S, Maggiore Q: A low-nitrogen diet with proteins of high biological value for severe chronic uraemia . Lancet 1:1000-1003, 1964.Crossref 4. Abel RM, Beck CH Jr, Abbott WM, et al: Improved survival from acute renal failure after treatment with intravenous essential l-amino acids and glucose . N Engl J Med 288:695-699, 1973.Crossref 5. Abel RM, Abbott WM, Fischer JE: Intravenous essential l-amino acids and hypertonic dextrose in patients with acute renal failure . Am J Surg 123:632-638, 1972.Crossref 6. Abbott WM, Abel RM, Fischer JE: Treatment of acute renal insufficiency after aortoiliac surgery . Arch Surg 103:590-594, 1971.Crossref 7. Abel RM, Abbott WM, Fischer JE: Acute renal failure: Treatment without dialysis by total parenteral nutrition . Arch Surg 103:513-514, 1971.Crossref 8. Darling RC: Ruptured arteriosclerotic abdominal aortic aneurysms . Am J Surg 119:397-401, 1970.Crossref 9. Ryan JA Jr, Abel RM, Abbott WM, et al: Catheter complications in total parenteral nutrition: A prospective study of 200 consecutive patients . N Engl J Med 290:757-761, 1974.Crossref 10. Tilney NL, Bailey GL, Morgan AP: Sequential system failure after rupture of abdominal aortic aneurysms: An unsolved problem in postoperative care . Ann Surg 178:117-122, 1973.Crossref 11. Baker AG Jr, Roberts B, Berkowitz HD, et al: Risk of excision of abdominal aortic aneurysms . Surgery 68:1129-1134, 1970. 12. Thompson JE, Vollman RW, Austin DJ, et al: Prevention of hypotensive and renal complications of aortic surgery using balanced salt solution: Thirteen-year experience with 670 cases . Ann Surg 167:767-778, 1968.Crossref 13. Powers SR Jr, Boba A, Hostnik W, et al: Prevention of postoperative acute renal failure with mannitol in 100 cases . Surgery 55:15-23, 1964. 14. Barry KG, Malloy JP: Oliguric renal failure, evaluation and therapy by the intravenous infusion of mannitol . JAMA 179:134-137, 1962.Crossref 15. Abbott WM, Austen WG: The reversal of renal cortical ischemia during aortic occlusion by mannitol . J Surg Res 16:482-489, 1974.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Sep 1, 1975

References