RENAL IMPAIRMENT IN HEPATIC CRYOTHERAPY

Cryoshock is a syndrome of coagulopathy, renal, and pulmonary injury f ollowing cryotherapy, and its etiology is unknown. The aim of this stu dy was to assess the impact of hepatic cryotherapy on renal function, and whether this effect is related to volume of cryotherapy, and to id entify any predictors of renal impairment in patients who undergo cryo therapy. A retrospective analysis of all patients with primary or seco ndary hepatic malignancy treated with cryotherapy from April 1990 to O ctober 1996 was conducted. Ten of 204 patients with renal impairment ( elevation in creatinine of greater than 0.02 mmol/L for more than 2 da ys postprocedure) were identified. One patient had postoperative pancr eatitis with late renal impairment (20 days) and was excluded. The sev erity of renal impairment was usually modest (mean rise in creatinine of 0.31 mmol/L; SD, 0.19). Two patients required temporary hemodialysi s. Only one patient, who had significant cardiac disease, had associat ed pulmonary injury and shock. Demographic data in both groups were co mparable, except for a trend toward more noncolorectal cancer patients in the renal impairment group (4/9 vs 33/194). Patients in the renal impairment group had a greater number of lesions than those of the non renal impairment group (3.4 vs 2.1, P < 0.01), as well as larger lesio n diameter (2.9 vs 1.9, P < 0.01), increased freezing time (74.7 vs 44 .3, P < 0.01), and a higher aspartate transaminase (AST) (2254 vs 1157 , P < 0.01). This study suggests that renal impairment is more likely to be seen in patients undergoing more extensive cryotherapy. The numb er and diameter of lesions together with AST data link renal injury wi th magnitude of liver injury-all renal impairment patients had an AST > 1000, compared with only 28% of patients who did not. (C) 1998 Acade mic Press.