Multiple renal injuries lead to death in postoperative cardiac surgery even with precocious hemodiafiltrations

Q4 Medicine
M. Bizubac, Cirstoveanu Catalin Gabriel, C. Filip, A. Nicolescu, I. Barascu, Ruxandra Chirca, A. Gaiduchevici, D. Pleșca
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引用次数: 0

Abstract

We present the case of a newborn diagnosed with perinatal asphyxia and secondary renal injuries, transposition of the great vessels and low systemic blood flow, treated with Prostaglandin, atrioseptostomy, followed by arterial switch surgery After the cardiac surgery the patient is oliguric and requires hemodiafiltration for 12 days, after which renal function is restored. In evolution, however, AVB (atrioventricular block) grade III occurs, followed by implantation of permanent pacemaker, but another postoperative complication – chylothorax – leads to stopping electrical stimulation followed by severe cardiac dysfunction and, consequently, recurrent renal injury and anuria. Re-establishing hemodiafiltration for another 7 days without recovery of renal function. Perinatal asphyxia, cardiac heart disease with low systemic blood flow, prostaglandin, atrioseptostomy, cardiac rhythms disturbances, chylothorax, sepsis, cardiac arrest are intriguing factors that bring renal injury. Their association greatly decreases the chance of survival even if the patient benefits from supportive treatment and early hemodiafiltration.
心脏手术后多发性肾损伤导致死亡,即使是早期血液透析滤过
我们报告一例新生儿被诊断为围产期窒息和继发性肾损伤,大血管转位和全身血流量低,接受前列腺素治疗,房间隔造口术,随后进行动脉转换手术。心脏手术后,患者少尿,需要血液滤过12天,之后肾功能恢复。然而,在进化过程中,发生AVB(房室传导阻滞)III级,随后植入永久性起搏器,但另一种术后并发症-乳糜胸-导致电刺激停止,随后出现严重的心功能障碍,从而导致复发性肾损伤和无尿。血液滤过恢复7天,肾功能未恢复。围产期窒息、全身血流量低的心脏疾病、前列腺素、房间隔造口术、心律紊乱、乳糜胸、败血症、心脏骤停都是引起肾损伤的有趣因素。即使患者受益于支持性治疗和早期血液滤过,它们的相关性也大大降低了生存的机会。
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来源期刊
CiteScore
0.10
自引率
0.00%
发文量
15
审稿时长
4 weeks
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