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Charles E. Lucas, MD; Celestine Harrigan, PhD; Ronald Denis, MD; Anna M. Ledgerwood, MD

Arch Surg. 1983;118(5):642-645.

Abstract
• Renal concentrating ability was tested in 20 severely injured patients who received an average of 21 blood transfusions. Timed measurements were made of urine output (UO), and the clearance of creatinine glomerular filtration rate (GFR), sodium (C_Na), osmols (C_osm), and free water (C_H2o) during operation and were repeated at 12 and 18 hours postoperatively, and on postoperative days 2 and 4. During operation the GFR was markedly reduced (36 mL/min), while UO, C_Na, and C_osm were all markedly increased (8.5, 5.9, and 8.1 mL/min, respectively). The C_H2o was positive (0.4 mL/min). Following operation the rate of renal excretion of water and solutes was still high: UO, 4.0 mL/min; C_Na, 4.3 mL/min; and C_osm, 6.0 mL/min. Five hours postoperatively the C_H2o had returned to normal. By day 2 the excretion rate of water had returned closer to normal: UO, 2.1 mL/min; C_Na, 2.6 mL/min; C_osm, 4.0 mL/min; the C_H2o was normal. Subsequent study results were normal. These data demonstrate a renal concentrating impairment during and following operation. An osmotic diuresis, transient tubular ischemia, a washout of interstitial inner medullary osmoles, or some cryptic factor may be causative.

(Arch Surg 1983;118:642-645)

Author Affiliations
From the Departments of Surgery, Wayne State University, Detroit, and Detroit Receiving Hospital.

Footnotes
Accepted for publication Jan 3, 1983.

Read before the 90th annual meeting of the Western Surgical Association, Kansas City, Mo, Nov 16, 1982.

Reprint requests to Department of Surgery, Detroit Receiving Hospital, 4201 St Antoine, Detroit, MI 48201 (Dr Lucas).

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