Evaluation of the value of epidural anesthesia in improvement of renal functions in preeclamptic patients with early renal impairment

Abstract

Objective This study aimed to evaluate the value of epidural anesthesia in improving renal functions in preeclamptic patients with early renal impairment. Patients and methods The study included 60 patients of ASA (American Society of Anesthesiologists) physical status II–III, age range 19–40 years, found to have mild preeclampsia with early renal impairment. The patients were divided randomly into two groups. Epidural anesthesia was administered in the epidural anesthesia (Epi) group (n=30), whereas patients in the control (Cont) group (n=30) were subjected to the same procedure for epidural catheter insertion, but not activated (except after the study time), and then treated by conventional measures according to the protocol of the Obstetric ICU of Ain Shams University Hospitals. For each patient, the following data were collected: hemodynamic changes, urine output, and renal function [detected by cystatin C, serum creatinine, blood urea nitrogen, and then estimation of glomerular filtration rate (GFR)]. Results There was a statistically significant reduction in blood pressure (systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure) in the Epi group after 15 min of epidural activation on comparing subsequent measures with the baseline value (T0) and also compared with the corresponding values in the Cont group. Also, the Epi group showed a statistically significant increase in urine output after 2 h of epidural activation, in comparison with baseline values and compared with the Cont group. Patients in the Epi group showed a statistically significant decrease in serum cystatin C and increase in estimated GFR (eGFR) on the basis of cystatin C after 2 h of a sympathetic block by epidural activation in comparison with the baseline value and compared with the Cont group, indicating a marked improvement in GFR. However, measurement of the urine protein/creatinine ratio, serum creatinine, blood urea nitrogen, and eGFR on the basis of serum creatinine indicated no significant difference in both groups compared with the baseline of the same group or on comparing both groups together. Conclusion Performing a renal sympathetic block by epidural anesthesia helps improve renal function with better control of blood pressure in preeclamptic patients with an early renal impairment detected by the sensitive renal marker cystatin C. Introduction Preeclampsia is a pregnancy-specific, multisystem disorder that is characterized by the development of hypertension and proteinuria after 20 weeks of gestation. This disorder complicates ∼5–7% of pregnancies and is considered one of the leading causes of maternal and fetal morbidity and mortality 1. Altered renal function is an essential component of the pathophysiology of preeclampsia, and close monitoring of renal function is essential to ascertain the optimal time for delivery to avoid renal damage 2. Glomerular filtration rate (GFR) is a representative index of renal function.