Preventing acute kidney injury after noncardiac surgery.
OBJECTIVE
In surgical patients, outcome is strictly dependent on the occurrence of postoperative complications, and a postoperative failing kidney has a significant independent effect on outcome. Acute kidney injury (AKI) occurs in 1% of noncardiac surgical patients and is commonly associated with more serious complications. It is important to prevent AKI wherever possible.


RESULTS
The mainstay of postoperative AKI prevention is perioperative maintenance of blood volume with adequate cardiac output by hemodynamic monitoring and fluids/inotropes infusion. There is a growing interest for pharmacological and metabolic interventions. Most interventions, however, have been predominantly evaluated in cardiac surgery and no definite conclusion can be translated in other settings. Tight control of glycemia is still matter of debate and a role, if any, may be limited to cardiac surgical patients.


CONCLUSIONS
Adopting adequate nephroprotective strategies is favored by knowing the moment of the actual insult to the kidney. Nevertheless, in the literature too many areas of uncertainty still exist due to the lack of renal risk stratification, of adequately powered studies, of uniform AKI definition, and of appropriate sample composition. The only recommendation for renal protection still consists in maintaining an optimal blood volume and an adequate cardiac output.
Brienza
Nicola
N
Emergency and Organ Transplantation Department, Anesthesia and Intensive Care Unit, University of Bari, Bari, Italy. nbrienza@rianima.uniba.it
Giglio
Maria T
MT
Marucci
Massimo
M
D000208:Acute Disease; D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control*; D009320:Atrial Natriuretic Factor; D002302:Cardiac Output; D018818:Fenoldopam / Q000627:therapeutic use; D006439:Hemodynamics; D006801:Humans; D019990:Perioperative Care; D011183:Postoperative Complications; D017582:Renal Replacement Therapy; D018570:Risk Assessment; D013997:Time Factors; D014665:Vasodilator Agents / Q000627:therapeutic use
D014665:Vasodilator Agents; D009320:Atrial Natriuretic Factor; D018818:Fenoldopam