Perioperative acute renal failure.
OBJECTIVE
Recent biochemical evidence increasingly implicates inflammatory mechanisms as precipitants of acute renal failure. In this review, we detail some of these pathways together with potential new therapeutic targets.


RESULTS
Neutrophil gelatinase-associated lipocalin appears to be a sensitive, specific and reliable biomarker of renal injury, which may be predictive of renal outcome in the perioperative setting. For estimation of glomerular filtration rate, cystatin C is superior to creatinine. No drug is definitively effective at preventing postoperative renal failure. Clinical trials of fenoldopam and atrial natriuretic peptide are, at best, equivocal. As with pharmacological preconditioning of the heart, volatile anaesthetic agents appear to offer a protective effect to the subsequently ischaemic kidney.


CONCLUSIONS
Although a greatly improved understanding of the pathophysiology of acute renal failure has offered even more therapeutic targets, the maintenance of intravascular euvolaemia and perfusion pressure is most effective at preventing new postoperative acute renal failure. In the future, strategies targeting renal regeneration after injury will use bone marrow-derived stem cells and growth factors such as insulin-like growth factor-1.
Mahon
Padraig
P
Department of Anaesthesia, Cork University Hospital, Wilton, Cork, Ireland. rsimahon@hotmail.com
Shorten
George
G
D058186:Acute Kidney Injury / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D000818:Animals; D006801:Humans; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D051381:Rats; D012307:Risk Factors