atrial-natriuretic-factor and Aortic-Aneurysm--Thoracic

Acute kidney injury (AKI) after surgery is associated with an increased risk of adverse events and death. Atrial natriuretic peptide (ANP) dilates the preglomerular renal arteries and inhibits the renin-angiotensin axis. A low-dose ANP infusion increases glomerular filtration rate after cardiovascular surgery, but it is not known whether it reduces the incidence of AKI or the mortality rate.. To evaluate whether an intravenous ANP infusion prevents AKI in patients undergoing aortic arch surgery requiring hypothermic circulatory arrest.. A randomised controlled study.. Operating room and intensive care unit at Kawasaki Saiwai Hospital, Kanagawa, Japan.. Forty-two patients with normal preoperative renal function undergoing elective repair of an aortic arch aneurysm.. Patients were assigned randomly to receive a fixed dose of ANP (0.0125 μg (-1) kg(-1)  min) or placebo. The infusion was started after induction of anaesthesia and continued for 24  h postoperatively.. The primary end-point was the incidence of AKI within 48 h after surgery.. AKI developed in 30% of patients who received ANP compared with 73% of patients who received placebo (P = 0.014). Intraoperative urine output was almost 1 l greater in patients who received ANP (1865 ± 1299 versus 991 ± 480  ml in the control group, P = 0.005). However, there were no differences in mean arterial pressure or number of episodes of hypotension between the groups. Length of hospital and intensive care stays were not significantly different, nor was there a difference in 30-day mortality. No patients required haemodialysis or continuous renal replacement therapy.. We found that an intravenous infusion of ANP at 0.0125  μg  kg(-1)  min(-1) is an effective intervention for reducing the incidence of postoperative AKI, and appears to afford a degree of renal protection during and after cardiovascular surgery.. Kawasaki ANP trial, UMIN Clinical Trials Registry ID: UMIN000011650.

Topics: Acute Kidney Injury; Adult; Aged; Aged, 80 and over; Aortic Aneurysm, Thoracic; Arterial Pressure; Atrial Natriuretic Factor; Circulatory Arrest, Deep Hypothermia Induced; Double-Blind Method; Humans; Incidence; Infusions, Intravenous; Japan; Length of Stay; Male; Middle Aged; Postoperative Complications; Prospective Studies

Acute kidney injury is a common complication after aortic surgery. Carperitide, a human atrial natriuretic peptide, was reported to be effective for preventing acute kidney injury after cardiac surgery. However, most studies were from single centers, and results of meta-analyses are subject to publication bias. The aim of the present study was to investigate whether carperitide preserved renal function in patients undergoing cardiovascular surgery.. Retrospective cohort study.. Participating hospitals (N = 281) in a national database from 2010 to 2013.. Adult patients (N = 47,032) who underwent cardiovascular surgery.. None.. The main intervention variable investigated was the use of carperitide on the day of surgery. Assessed outcomes included receiving renal replacement therapy within 21 days of surgery and in-hospital mortality. Data were available for 47,032 patients, of whom 2,186 (4.6%) received carperitide on the day of surgery. Multivariate logistic regression analysis revealed that carperitide was significantly associated with a greater likelihood of receiving renal replacement therapy within 21 days of surgery, but not with in-hospital mortality.. In patients undergoing cardiovascular surgery, carperitide significantly increased the odds of receiving renal replacement therapy within 21 days after surgery.

Topics: Aged; Aortic Aneurysm, Thoracic; Atrial Natriuretic Factor; Cardiac Surgical Procedures; Cohort Studies; Female; Humans; Male; Middle Aged; Postoperative Complications; Renal Replacement Therapy; Retrospective Studies

A 49-year-old man had sudden chest pain and paralysis of the lower right limb. An acute aortic dissection was diagnosed in a computed tomography scan and the patient underwent an emergency operation. After the operation, myonephropathic metabolic syndrome developed, and human atrial natriuretic peptide was administered for 11 days until the volume of daily urine output reached at least 10,000 mL, which would facilitate limb salvage and the preservation of life without hemodialysis. This report documents that postoperative myonephropathic metabolic syndrome improved due to the strong diuretic action of human atrial natriuretic peptide without hemodialysis.

Topics: Acute Disease; Aortic Aneurysm, Thoracic; Aortic Dissection; Atrial Natriuretic Factor; Blood Vessel Prosthesis Implantation; Dose-Response Relationship, Drug; Follow-Up Studies; Humans; Infusions, Intravenous; Male; Metabolic Diseases; Middle Aged; Postoperative Complications; Radiography; Rhabdomyolysis; Syndrome