Countermeasures against postoperative acute renal failure

Of 5016 consecutive cases of surgery during the period between January 1966 and to April 1982 at the First Department of Surgery, Fukushima Medical College Hospital, 89 (1.8%) patients had postoperative acute renal failure, with a survival rate of only 34.8%. Since 1975, we have employed the follwing therapy: 1) hemodynamic management using the Swan-Ganz thermodilution catheter; 2) early detection by free water clearance; 3) administration of large quantities of diuretics, and 4) early application of dialysis. As a result, we improved our survival rate from 18.8% to 43.6%. Nineteen (51%) out of 37 patients treated with hemodialysis showed good results, while the corresponding ficures were 38% with large quantities of diuretics and 13% with peritoneal dialysis. Early application of hemodialysis was considered the best therapy for acute renal failure. Postoperative acute renal failure is one of the most frequently observed phenomena of multiple organ failure. Our results showed if complicated organ failure, such as respiratory failure, heart failure, hepatic failure, bleeding from the digestive system, etc., were increased, the prognosis of acute renal failure worsened. In conclusion, early detection of renal failure and early application of hemodialysis improved the therapy for postoperative acute renal failure. In addition, treatment for other complicated organ failures was important.