Case report: proximal tubule impairment following volatile anesthetic exposure

• Published in: Physiological reports 2015-09, Vol.3 (9), p.e12560-n/a
• Main Authors: Ray, Evan C., Abdel‐Kader, Khaled, Bircher, Nicholas, Rondon‐Berrios, Helbert
• Format: Article
• Language: English
• Subjects: Anesthesia; Anesthetics; Case Reports; Desflurane; Glucose; glucosuria; glycosuria; Hyperglycemia; Hypotheses; inhalation anesthetic; Ischemia; isoflurane; Ketonuria; kidney function; Kidneys; Metabolism; Nephrology; Nephropathy; Neurosurgery; Patients; phosphaturia; Physiology; Potassium; Proteins; Proteinuria; proximal tubule; renal tubular acidosis; sevoflurane; Sodium; Surgery; type II RTA; Urine; volatile anesthetic
• ISSN: 2051-817X; 2051-817X
• DOI: 10.14814/phy2.12560

The safety of contemporary volatile anesthetic agents with respect to kidney function is well established, and growing evidence suggests that volatile anesthetics even protect against ischemic nephropathy. However, studies examining effects of volatile anesthetics on kidney function frequently demonstrate transient proteinuria and glycosuria following exposure to these agents, although the cause of these findings has not been thoroughly examined. We describe the case of a patient who underwent a neurosurgical procedure, then experienced glycosuria without hyperglycemia that resolved within days. Following a second neurosurgical procedure, the patient again developed glycosuria, now associated with ketonuria. Further examination demonstrated nonalbuminuric proteinuria in conjunction with urinary wasting of phosphate and potassium, indicative of proximal tubule impairment. We suggest that transient proximal tubule impairment may play a role in the proteinuria and glycosuria described following volatile anesthetic exposure and discuss the relationship between these observations and the ability of these agents to protect against ischemic nephropathy. This case report describes a patient who underwent a series of neurological surgeries, with clinical findings suggesting impairment of the kidney's proximal tubule following each procedure. Literature is reviewed showing that exposure to volatile anesthetics is associated with transient glycosuria, proteinuria, and urinary elaboration of β‐2‐microglobulin and α‐GST, consistent with proximal tubule impairment. Authors hypothesize that volatile anesthetic agents can transiently impair proximal tubule function and discuss the relationship between these findings and recent literature showing that volatile anesthetics protect kidneys against ischemic damage.