Enflurane renal effects

Cousins MJ, Greenstein LR, Hitt BA, Mazze Rl. Metabolism and renal effects of enflurane in man. Anesthesiology 1976 44(1) 44-53. 

Mazze Rl, Sievenpiper TS, Stevenson J. Renal effects of enflurane and halothane in patients with abnormal renal function. Anesthesiology 1984 60 161-163. 

Numerous studies have addressed the same issues raised with enflurane regarding fluoride production and nephrotoxic potential including fluoride levels after prolonged exposure [56,57,59], urine concentrating ability [57, 59-61], the effect of obesity [57, 60], and the effect of preexisting renal function impairment [62,63]. The findings demonstrated that sevoflurane has little or no potential for fluoride-induced nephrotoxicity (For further information see section on mechanisms of fluoride toxicity). 

Hysing ES, Chelly JE, Doursout M-F, Merin RG. Comparative effects of halothane, enflurane, and isoflurane at equihypotensive doses on cardiac performance and coronary and renal blood flows in chronically instrumented dogs. Anesthesiology 1992 76 979-984. 

Enflurane reduces renal blood flow, glomerular filtration rate, and urinary output. These effects are rapidly reversed upon drug discontinuation. There is scant evidence of long-term nephrotoxicityfollowing enflurane use, and it is safe to use in patients with renal impairment provided that the depth of enflurane anesthesia and the duration of administration are not excessive. Enflurane reduces splanchnic and hepatic blood flow in proportion to reduced arterial blood pressure but does not appear to alter liver function or to be hepatotoxic. 

Isoniazid may increase the metabolism of enflurane, isoflurane or sevoflurane in some patients (probably related to isoniazid acetylator phenotype ) and so increase the release of fluoride ions that may cause nephrotoxicity. However, there do not appear to be any reports of a significant clinical effect on renal function. 

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