小児外科手術前後における乏尿病態の検討 : とくにRenin-Angiotensin系を中心に
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Oliguric conditions accompanying renal failure associated with severe diseases treated by pediatric surgery were investigated in 24 cases. During the period from admission up to between three and seven days after surgery, renal function was evaluated through the following parameters: (1) excreted urin volume, (2) S-cr and BUN, (3) urine osmotic pressure and U/P Osm and (4) urine concentration of Na and FENa. Changes in PR A and A-II were also observed. Standard values of PRA and A-II had been determind. PRA and A-II were highly correlated, with maximal values in the neonatal period, which thereafter showed an age-dependent decrease. Parameters for evaluating renal function were reliable, S-cr and FENa being especially useful. With regard to oliguric conditions on admission, a neonatal death group represented acute nephric renal failure, and a surviving group represented the transition from prenephric renal failure to nephric renal failure, while corresponding infant and child groups represented prenephric renal failure. On the other hand, a surviving neonatal group represented the pre-symptoms of nephric renal failure for two or three days after surgery even if diuresis was obtained. Activated and/or increased PRA and A-II were considered to contribute to the occurrence of oliguria leading to nephric renal failure. Dopamine, combined with fluid transfusion, was useful for oliguria on admission, being especially effective for prenephric renal failure. Inhibition of increase in the renin-angiotensin system for neonates with presymptoms of nephric renal failure was necessary even if diuresis was found, suggesting that early usage of captopril was desirable.
- 日本小児外科学会の論文
- 1986-02-20
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