Shock and the kidney: pathophysiology and pharmacological support

Effects of lysine-vasopressin treatment on renal function in burned pigs

The effects of lysine vasopressin (LVP) on renal excretory function and renal blood flow were studied in anesthetized and burned pigs either treated conservatively or by early excision 5 hours after burn. Renal perfusion was measured with radioactive microspheres. Diuresis and the urinary excretion of sodium and potassium were determined. Glomerular filtration rate (GFR) was measured either as the endogenous creatinine clearance rate or the clearance rate of 51Cr-EDTA. LVP-treatment in pharmacologic doses after burn caused larger diuresis, and larger sodium and potassium excretion rates than in unburned controls and animals submitted to burn only, Renal blood flow decreased significantly early after burn whether LVP was given or not. After burn, GFR was moderately higher in the LVP-treated pigs than in the animals submitted to burn only. After 24 hours S-creatinine was lower in the pigs treated by LVP and excision of the burned tissues after 5 hours, compared with the conservatively treated animals. This implies that an active surgical approach to full thickness skin burns might support renal function. LVP-induced intrarenal effects causing increased GFR and secondary medullary interstitial electrolyte concentration and osmolar changes could be the mechanisms causing the renal functional changes found in this investigation.

Survial from acute renal failure with and without multiple organ dysfunction

A 10-year retrospective analysis has been carried out of 114 patients dialysed for acute renal failure. Fifty-eight patients, predominantly suffering from multiple organ failure, required treatment in an Intensive Therapy Unit (ITU); 56 less severely ill patients were treated in a Renal Unit. Overall survival in the former group was 36% and in the latter group 63%. In the first 5 years of the study, survival in the ITU patients was 31% and in the second 5 years, was 38% in spite of a trend towards increased severity of illness. These results challenge the view that haemodialysis is rarely worth-while in patients with multiple organ failure, and suggest that current management techniques have improved prognosis. The most important adverse factors continue to be old age, sepsis and gastrointestinal disease.

The effects of insulin glucose administration in fulminant hepatic failure

Insulin glucose therapy can correct hyponatraemia and renal sodium retention in burns, sepsis and circulatory failure. A case of fulminant hepatic failure (F.H.F.) is described in which the same effect was observed. Insulin was thought to have corrected abnormal cell membrane permeability. The actions of insulin are discussed in relation to its possible role in the management of F.H.F.