Prevention of perioperative acute renal failure: what works?
Perioperative acute renal failure (ARF) is associated with increased morbidity and mortality. Patients undergoing cardiac, vascular and major abdominal surgery and those with pre-operative renal insufficiency are at increased risk for developing post-operative ARF. The aetiologies of perioperative ARF are multi-factorial. However, pre-renal azotaemia and ischaemic acute tubular necrosis (ATN) are the predominant causes. Preventive strategies involve identifying patients at risk, optimizing intravascular volume as well as renal function with perioperative haemodynamic monitoring, and avoiding nephrotoxins. Various pharmacological agents have been used to optimize renal perfusion and tubular function. Unfortunately, none has been shown to be effective in randomized placebo-controlled trials. In this chapter, we discuss the prophylactic use of fluids, vasoactive drugs, diuretics and other agents, as well as modification of surgical techniques to reduce the incidence of perioperative ARF.
Tang
Ignatius Y
IY
Section of Nephrology, Department of Medicine, University of Chicago Hospitals, Chicago, IL, USA.
Murray
Patrick T
PT
D058186:Acute Kidney Injury / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control*; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D007431:Intraoperative Complications / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control*; D019990:Perioperative Care; D018570:Risk Assessment