Peri‐operative assessment of glomerular permeability

Surgical trauma may provoke an increase in glomerular permeability. Microalbuminuria is a subclinical increase in urinary albumin ranging from 20 to 300 mg..-1. This cannot be measured with routine laboratory tests and is estimated by radioimmunoassay. It has been proposed that microalbuminuria, an expression of increased glomerular permeability, serves to reflect a generalised increase in systemic vascular permeability. In this study the degree of microalbuminuria (expressed as microalbuminuria/creatinine ratio to correct for dilutional changes) has been measured in two groups of patients undergoing either videolaparoscopic surgery (group A) or conventional, open, abdominal surgery (group B). The anaesthetic technique was standardised and the duration of surgery similar in the two groups. A significant increase (p < 0.01) in the microalbuminuria/urinary creatinine ratio occurred in patients undergoing open abdominal surgery (group B). This alteration appeared 2 h after surgery but had disappeared 24 h after the end of the operation. During surgery, there was a direct relationship between glomerular permeability and the severity of the surgical insult.