Effects of traumatic hypovolemic shock on renal function

Renal and systemic hemodynamic evaluations were made in 16 patients within 12- to 72-hr after injury in an effort to determine the effects of severe traumatic hypovolemic shock on renal function. Eleven patients were again studied in the convalescent period. All patients had stable vital signs at time of renal evaluation and no patient received vasopressors or diuretics within 24 hr of study. The early postresuscitative period was associated with a significant reduction in effective renal plasma flow, true renal plasma flow, true renal blood flow, renal oxygen consumption, and the percentage of renal blood flow compared to the total cardiac output; renal vascular resistance, osmolar clearance, and sodium clearance were increased at this time. The glomerular filtration rate, extracellular fluid space, cardiac output, and total peripheral resistance remained normal. All abnormal renal parameters returned to normal with convalescence except in those patients who developed nonoliguric renal failure which was associated with a persistant decrease in glomerular filtration rate and effective renal plasma flow during convalescence. The clinical significance of these findings including the roles of loop diuretics and vasodilators are discussed.