Regional Renal Hypothermiaによる腎部分切除術後にみられた無尿

Abstract

This is a case report of anuria which developed after regional hypothermia for renal surgery. Partial nephrectomy for functionally solitary kidney with calculi was performed under regional hypothermia using saline slush. Anuria lasted 60 minutes after declamping of the renal pedicle. In this case, the renal ischemia was necessary for 33 minutes during which period the kidney temperature was kept 15 to 20°C. No urine output was observed 30 minutes after declamping of the renal pedicle. Pulsation of the renal artery was weak and the renal parenchyma showed a poor expansion. The kidney temperature returned slowly and showed 27"C 15 minutes after declamping. From the above findings, cause of anuria was thought to be the impaired renal circulation due to contraction of the intrarenal vessels. 100 mg of dopamine was administered at a rate of 5 µg/kg/min. Diuresis started in 30 minutes (60 minutes after declamping). Amount of urine was measured to be 50 ml for the first 15 minutes, 90 ml for the second and 150 ml for the following 30 minutes. The patient then took an uneventful course. In case of kidney surgery associated with clamping of the renal pedicle under hypothermia, unnecessary manipulation of the kidney and over returning to the normal of the renal vessels should be avoided. Whenever kidney remains soft and slow in returning to the normal temperature, decreased renal circulation due to contraction of the intrarenal vessels should be kept in mind. Dopamine was proved to be effective to combat such condition.