URINARY-EXCRETION OF PROSTAGLANDINS AND RENAL-FUNCTION AFTER HEPATIC RESECTION

Background/Aims: The leading postoperative complication associated wit h hepatic resection. is the accumulation of fluid in the abdominal cav ity, which usually develops approximately one week after surgery. This study was undertaken to investigate the role of renal prostaglandins in modulating renal sodium and water retention in patients who underwe nt hepatic resection. Methods: Urinary excretion of thromboxane B-2 an d 6-keto-prostaglandin F1a as well as renal function were investigated serially in 7 patients with hepatocellular carcinoma who underwent he patic resection. We administered 60 mg of OKY 046, a selective thrombo xane A(2) synthetase inhibitor, for 6 hours by continuous drip infusio n from the commencement of surgery. Results: Urinary sodium excretion was reduced from 165 mEq/day pre-operatively to 73 mEq/day on post-ope rative day 6 (p=0.0181), however, there was no decline in urinary osmo rality. OKY 046 administration, inhibited intrarenal thromboxane A(2) production, on the other hand, it significantly increased the producti on of intrarenal prostaglandin I-2 (from 147 +/- 19 to 6339 +/- 1861 p g/mg creatinine, p=0.0017) on the day of surgery. The level of thrombo xane A(2) was significantly increased to 2440 +/- 1099 pg/mg creatinin e (p=0.006, vs. pre-operative value), whereas the level of prostagland in I2 was significantly reduced to 687+/-163 pg/mg creatinine (p=0.018 1, vs. the value on the day of surgery) on postoperative day 6. Conclu sions: Urinary thromboxane A(2) synthesis might contribute to sodium a nd water retention after hepatic resection. These results suggest that combined use of OKY 046 and diuretics prevent ascites formation, afte r hepatic resection.