| Acute Renal Failure after Operation Associated with Aprotinin: Report of 3 cases. |
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Sun Chong Kim, Hee Sang Eom, Si Young Ok, Soon Im Kim |
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Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital, Seoul, Korea. soonnim@hosp.sch.ac.kr |
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| Abstract |
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Aprotinin is a serine protease inhibitor and a powerful antifibrinolytic agent, derived from the inhibition of plasmin and kallikrein. Therefore, it is widely used in cardiopulmonary bypass surgery or major surgery for reducing bleeding and blood transfusion requirements. Aprotinin is rapidly eliminated from the circulation by glomerular filtration and is actively reabsorbed in the renal tubular system, where it is stored, metabolized, and eliminated over the following 5-6 days. Because of this metabolism, concerns have been raised regarding the possibility that aprotinin may impair renal function due to a toxic effects on proximal tubular cells. We report three cases of postoperative renal failure after aprotinin had been used during surgery. Two patients, Jehovah's Witnesses who refused blood transfusion, required hemodialysis. One patient, who underwent spinal orthopedic surgery, was administered aprotinin to reduce intraoperative blood loss, and developed acute renal dysfunction. The patient recovered after supportive therapy. |
| Key Words:
aprotinin; complication; acute renal failure |
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