Cardiopulmonary bypass and the kidney

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Abstract
Renal failure after cardiac surgery is associated with high morbidity and mortality. During cardiac surgery, cardiopulmonary bypass (CPB) is associated with many physiological disturbances that may result in renal ischemia, particularly to the medullary thick ascending limb of the loop of Henle. Prevention of ischemic insult by maintaining the oxygen supply and demand balance is more effective than pharmacologic intervention once renal failure is established. Pulsatile flow allows higher pump flows for a given perfusion pressure. Maintaining high flows during moderate hypothermic CPB maintains renal blood flow. Avoiding an increase in metabolic demand by decreasing sodium and water reabsorption is also desirable.

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