Nature of Postischaemic Renal Injury Following Aortic or Cardiac Surgery

Three decades have elapsed since surgical correction of abdominal aortic aneurysms and cardiac valvular disease was first undertaken. Throughout the 1950s and early 1960s such surgery was associated with intense renal vasospasm. At least one-third of patients exhibited prolonged postoperative oligoanuria and 20% went on to die of acute renal failure (ARF). By 1963 this field of surgery was transformed by the discovery that intraoperative infusion of hypertonic mannitol largely prevented oliguria and ARF in patients undergoing abdominal aortic aneurysmectomy (Barry et al. 1961). Soon after, mannitol infusion was applied to open cardiac surgery. Once again, oligoanuria was overcome and the incidence of postcardiac surgical ARF sharply reduced (Dobernak et al. 1962). Today, the overall incidence of ARF following abdominal aortic or open cardiac surgery has been reduced to 5% or less in large, experienced centres (Abbott 1980; McCombs and Roberts 1979; Hilberman et al. 1979; Abel et al. 1976). However, because prophylactic mannitol together with other advances in anaesthesia and surgery have greatly increased the frequency of these surgical procedures, they remain among the commonest discrete causes of haemodynamically mediated ARF, nevertheless.