ACUTE-RENAL-FAILURE FOLLOWING PULMONARY SURGERY

Objective. To determine incidence, predisposing factors, and outcome o f acute renal failure complicating pulmonary surgery. Design. Retrospe ctive review. Setting. Tertiary cancer hospital. Patients. Patients un dergoing pulmonary resection over a 25-year period. Measures. Morbidit y and mortality of postoperative acute renal failure. Results. Six of 1595 (0.4%) patients developed acute renal failure. All 6 patients had advanced thoracic malignancies that required extensive resections. No patient undergoing simple lobectomy, or lesser pulmonary resection, d eveloped acute renal failure. Sepsis and respiratory failure were pres ent in all 6 patients prior to onset of acute renal failure. All patie nts died of multiple organ failure. Conclusions. The incidence of acut e renal failure following pulmonary surgery is very low. Management st rategies developed for other surgical patients may not be appropriate in the setting of pulmonary surgery. Specific perioperative preventive measures, such as intravenous fluid loading, are not warranted and ma y be harmful. Acute renal failure after pulmonary surgery has a very h igh mortality. Associated post-operative complications, such as sepsis and respiratory failure, are largely responsible for this high mortal ity. Treatment of acute renal failure in pulmonary surgery patients co nsists of maintenance of tissue oxygenation, elimination of sepsis, nu tritional support, and dialysis or hemofiltration.