Tuesday, December 14, 2010

TOPIC DISCUSSION: Anesthetics and Kidney Disease

Do Anesthetic agents cause Renal Disease?
A recent discussion in a nephrology forum this above question was asked. Evidence on this is scant. On literature review, few cases reports found in 1960-80s and none after that. Perhaps we have not been using these agents anymore.  Some of the older agents might have cause renal disease.  In animal experiments, kidney damage has been reported after low level exposure of halothane.  Few case reports exist of methoxyflurane causing renal dysfunction.  There was a retrospective cohort study and it reported a higher frequency of kidney disease among exposed persons especially women ( in 1968).  Moderate to temporary effect on kidney function has been shown  in patients who got methoxyflurane.  Rats were subjected to chronic exposure to low levels of halothane (10 and 500 ppm for 8 and 4 weeks, respectively). Kidney histology showed proximal tubular changes and mitochondrial injury.
In the 1960s, the widespread use of the inhalational anaesthetic methoxyflurane was associated with a significant occurrence of postoperative renal dysfunction. This was attributed to hepatic biotransformation of methoxyflurane and subsequent release of inorganic fluoride ions into the circulation. It was found that this was more due to the drug containing massive amounts of fluoride and this was all fluoride toxicity. Nowadays, fluoride-related toxicity has been observed neither in animal nor in clinical studies, including prolonged administration and patients with pre-existing renal disease.


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