Abstract
A 58-year-old man underwent lower anterior rectal resection under general anesthesia for rectal cancer. He had no history of a specialized disease and his preoperative renal function was normal. The intraoperative and early postoperative course was uneventful, and 1 g of cefmetazole sodium (CMZ) for prevention of surgical site infection was administered every 12 hours since just before the operation. Approximately 36 hours after the operation, we noted a sudden onset of oliguria that persisted despite fluid volume loading and furosemide administration; 6 hours later, the oliguria progressed to anuria. Laboratory data at the onset of anuria showed elevated levels of blood urea nitrogen (25.8 mg/dl) and creatinine (3.37 mg/dl) and high fractional excretion of sodium (15.7%). Computed tomography revealed no ureter obstruction. A diagnosis of CMZ-induced acute renal failure (acute tubulointerstitial nephritis) was made. CMZ treatment was discontinued, and continuous hemodiafiltration (CHDF) was attempted. Forty-three hours later, urine production started and increased rapidly, after which, CHDF was discontinued. The patient's clinical course since then was uneventful, and he discharged 29 days after the operation.
