[每周一问]NO.34-perioperative assessment of renal function(part 1)
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1.How is oliguria defined?
2.Is oliguria a sign of renal hypoperfusion?
3.Does perioperative oliguria predict postoperative acute renal failure?
4.Alternatively, does a normal urinary output predict the absence of postoperative acute renal failure?
1 少尿的定义是什么？
2 少尿是否是肾脏低灌注的一个标志？
3 围术期少尿是否预示术后发生急性肾功能衰竭？
4 尿量正常是否可预测术后不发生进行急性肾功能衰竭？
参考答案（请战友指正)
1 少尿的定义是什么？
少尿定义为，尿量少于400 mL/day或少于0.25 to 0.33 mL/kg/h，尽管没有资料支持此定义的临床价值，但人们认为此尿量可以排除正常的每天的溶质性废物（主要是含氮废物）
2 少尿是否是肾脏低灌注的一个标志？
少尿不一定意味着肾脏低灌注，也不说明需要马上进行治疗。有很多正常和异常生理状态可导致少尿。进行少尿的诊断必须在动脉血容量和血流正常情况下，并进行了简单的诊断实验后才能确定。
3 围术期少尿是否预示术后发生急性肾功能衰竭？
大多数的临床研究表明少尿与急性肾衰有一定的关系。Alpert等对137名行主动脉重建的患者进行了研究，在手术过程中，患者通过输晶体液和甘露醇与速尿或不用这两种药物保持尿量少于0.125 ml / kg/hr，肺动脉楔压在正常范围，在术后1，3和7天观察血尿素氮和肌酐变化。最终，21名患者出现术后肾功不全。未发现术中平均或最低每小时尿量与术前和术后尿素氮、肌酐变化存在明显相关性。作者得出结论认为术中尿量不能够预测术后肾功不全。其他研究者的研究结果也证实了此结论。
4 尿量正常是否可预测术后不发生进行急性肾功能衰竭？
通常认为的正常尿量（0.25-0.33 mL/kg/h）并不意味着不发生术后肾功不全，事实上，非少尿性肾功不全常发生于烧伤、创伤、主动脉或冠脉重建等手术后，甚至发生于经尿道前列腺切除术术后。
英文参考答案
1 How is oliguria defined?
Oliguria is defined as a reduction in urine output to less than 400 mL/day or hourly urine outputs of less than 0.25 to 0.33 mL/kg/h (1). Although no data support the clinical value of this definition, the urine amounts sited are thought necessary to excrete the normal daily solute load (mostly nitrogenous wastes).
2 Is oliguria a sign of renal hypoperfusion?
Oliguria does not necessarily indicate renal hypoperfusion, nor suggest that immediate therapy need be established. There are many normal as well as abnormal physiologic states that can produce oliguria. Should oliguria occur, however, efforts should be made to ensure adequate arterial blood volume and flow, and simple diagnostic studies should be conducted.
3 Does perioperative oliguria predict postoperative acute renal failure?
The majority of clinical studies suggest a limited relationship between oliguria and acute renal failure (ARF). Alpert et al. (2) studying 137 patients during aortic reconstruction treated urinary outputs of less than 0.125 ml / kg/hr with crystalloid solutions with either mannitol and furosemide or nothing, maintaining pulmonary capillary wedge pressure within normal limits. Postoperatively on days 1, 3, and 7, BUN and creatinine levels were evaluated. While 21 patients ultimately demonstrated postoperative renal insufficiency, no significant correlation between intraoperative mean or lowest hourly urinary output and preoperative to postoperative changes in creatinine or BUN were noted. The authors concluded that intraoperative urine output does not appear predictive of postoperative renal insufficiency. Other investigators have corroborated these findings in the same patient population (3).
4 Alternatively, does a normal urinary output predict the absence of postoperative acute renal failure?
"Adequate or good" urinary outputs of greater than 0.25 to 0.33 mL/kg/h does not exclude the possibility of postoperative ARF. In fact, nonoliguric ARF commonly follows surgery for burns, trauma, aortic or coronary revascularization, and even TURP procedures (4).
References:
1.Rothenberg DM. Postoperative renal dysfunction. Problems in Anesthesia 2000;12:314-25.
2.Alpert RA, Roizen MF, Hamilton WK, et al. Intraoperative urinary output does not predict postoperative renal function in patients undergoing abdominal aortic revascularization. Surgery 1984;95:707-11.
3.Knos GB, Berry AJ, Isaacson IJ, Weitz FI. Intraoperative urinary output and postoperative blood urea nitrogen and creatinine levels in patients undergoing aortic reconstructive surgery. J Clin Anesth 1989;1(3):181-5.
4.Zaloga GP, Hughes SS. Oliguria in patients with normal renal function. Anesthesiology 1990;72(4):598-602.
5.Bilen CY, Sahin A, Ozen H, Aki FT, Oge O, Kendi S. Nonoliguric renal failure after transurethral resection of prostate. J Endourol 1999;13(10):751-4.
作者: 风雨同
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