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July 5, 1971

Renal Dysfunction With Methoxyflurane

Author Affiliations

Ann Arbor, Mich

JAMA. 1971;217(1):79. doi:10.1001/jama.1971.03190010061021

To the Editor.—  I read with considerable interest the article by Mazze et al entitled "Renal Function Associated with Methoxyflurane Anesthesia" (216:278, 1971). Random, prospective studies such as this are what will be required to settle the question of the effect of methoxyflurane on renal function.Unfortunately, I am unable to accept the explanation offered for the location in the nephron of the effect resulting from methoxyflurane. While inability to concentrate the urine in the presence of adequate amounts of antidiuretic hormone could be due to a distal convoluted tubule abnormality, it could also be due to failure of the sodium pump in the ascending limb of the loop of Henle, or to increased medullary blood flow. The former would prevent the establishment of, and the latter could wash out medullary hypertonicity. The way to distinguish distal tubule from loop dysfunction is to water load the patient. Those with