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April 1973

Altered Renal Homeostasis With Acute Sepsis: Clinical Significance

Arch Surg. 1973;106(4):444-449. doi:10.1001/archsurg.1973.01350160062010

Effects of sepsis on renal function were evaluated in 65 patients acutely ill with peritonitis from different causes. The indexes measured included glomerular filtration rate, effective renal plasma flow, true renal plasma flow, osmolar clearance, sodium clearance, and serum osmolar differences.

Average glomerular filtration rate and effective renal plasma flow were slightly depressed. Extraction of para-aminohippurate through the kidney was markedly decreased so that true renal blood flow was elevated in direct proportion to cardiac output. Urine volumes were usually high and many patients exhibited a syndrome of inappropriate polyuria at the expense of effective circulating plasma volume, leading to relative hypovolemia. Although average serum osmolality and osmolar difference were markedly elevated, the average osmolar clearance was within normal range. These data suggest that sepsis causes renal vasodilation. The therapeutic implications of these findings are discussed.