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      Nifedipine Can Preserve Renal Function in Patients Undergoing Aortic Surgery with Infrarenal Crossclamping

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          Sixteen patients diagnosed with an aneurysm of abdominal aorta or Leriche disease underwent elective aortic surgery involving crossclamping of infrarenal aorta (ICC). These patients were randomized into two equal groups and 8 patients were infused with nifedipine starting from the isolation of aorta until the end of surgery (group A) while another 8 patients were infused with low-dose dopamine (group B) over the same surgical course. Plasma endothelin (ET) was measured before the induction of anesthesia, at the beginning and at the end of the clamp period and at the end of the operation. Intraoperatively, creatinine clearance and urinary excretion of PGE<sub>2</sub>, 6-keto PGF<sub>1α</sub> and TxB<sub>2</sub> were also determined before, during and after aortic crossclamping. Pre-operative GFR as well as preinduction cardiac index (CI) and pulmonary capillary wedge pressure (PCWP) of the two groups did not differ. During crossclamping plasma ET rose significantly in both groups. However, after clamp removal, plasma ET decreased in group A while it remained elevated in group B. Urinary excretion of TxB<sub>2</sub>, PGE<sub>2</sub> and 6-keto PGF<sub>1α</sub> increased during clamp in both groups, but the ratio of PGE2 + 6-keto PGF<sub>1α</sub>/TxB<sub>2</sub> during and after clamp was significantly higher in group A than in B. Postclamp creatinine clearance decreased in group B, and increased in group A; postoperative value of GFR was unchanged in group A and decreased significantly in group B. In conclusion, infusion of nifedipine, in contrast to dopamine, prevented the decrease of GFR in patients undergoing aortic surgery. This effect could be mediated by a nifedipine modulation of ET vascular synthesis and/or a preferential renal synthesis of vasodilating prostanoids.

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          Author and article information

          S. Karger AG
          24 December 2008
          : 74
          : 4
          : 668-673
          aDivison of Nephrology, bIInd Department of Anesthesia, cIIIrd Division of Surgery, dDivision of Nuclear Medicine, Regional Hospital of Udine, and eInstitute of Internal Medicine, Division of Nephrology, University of Padova, Italy
          189472 Nephron 1996;74:668–673
          © 1996 S. Karger AG, Basel

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          Page count
          Pages: 6
          Original Paper

          Cardiovascular Medicine, Nephrology

          Renal function, Aortic surgery, Prostaglandins, Endothelin, Nifedipine


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