The role of pharmacological steroid therapy in preservation of renal function in severely injured patients requiring massive transfusion

Abstract

Purpose

Glucocorticoids (GC) attenuate the post-insult inflammatory response and have been observed to confer end-organ protection following a variety of ischemic insults. We aim to assess this benefit on renal perfusion and function in injured patients requiring massive transfusion.

Methods

The effect of pharmacologic methylprednisolone (MP) therapy was studied in 118 patients (pts), of whom 60, by random, received 1 g MP intraoperatively and 15 mg/kg for an additional 3 days. Postoperative measurements were made of effective renal plasma flow (ERPF), glomerular filtration by inulin (C_In), creatinine clearance (C_Cr) and clearances of osmoles (C_Cosm), sodium (C_Na), and free water ( \({\text{C}}__{ 2} {\text{O}}}}\) ). Continuous variables were compared between the two groups using the student’s t test.

Results

Enrolled pts on average received 13.5 units of PRBCs with no differences in the resuscitation regimen. There were no statistically significant differences in the postoperative renal function as measured by ERPF (p = 0.57), C_In (p = 0.84), C_Cr (p = 0.99), C_Na (p = 0.07), C_Osm (p = 0.95), and \({\text{C}}__{ 2} {\text{O}}}}\) (p = 0.33). The incidence of renal compromise, as determined by an inulin clearance of <25 mL/min or serum creatinine greater than 3.0 mg/dL, was also similar. Three patients in the MP treatment group had renal compromise compared to one in the control group.

Conclusions

In the absence of larger studies, this study demonstrates that GC likely have no role in preserving renal function in severely injured patients.

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