title: Renal dysfunction and fluid and electrolyte disturbances.
abstract: OBJECTIVE
  To examine recent developments in preventing and treating postoperative acute renal dysfunction. To review contemporary issues concerning perioperative fluid and electrolyte management.
  
  
  RESULTS
  Renal dysfunction remains a major postoperative morbidity despite the advent of intermittent and continuous renal replacement therapies. It is also associated with increased mortality. Newer techniques, such as off-pump coronary artery bypass surgery, which promised to reduce the incidence of postoperative renal injury, have failed to do so. In addition, newer techniques such as endovascular repair of aortic disorder and the transcutaneous insertion of aortic valves are associated with substantial degrees of kidney injury partially due to the use of much intravenous contrast material. Therefore, the present-day approach to preventing contrast-induced nephropathy is reviewed. Electrolyte disturbances are especially problematic after certain types of surgery, such as trans-sphenoidal adenomectomy and surgeries requiring the use of large volumes of irrigating solutions.
  
  
  CONCLUSIONS
  Renal dysfunction, along with fluid and electrolyte disturbances, is a major issue that needs to be considered as part of perioperative management. Moreover, it is the prevention of clinically significant renal injury and electrolyte disturbances that is the cornerstone of contemporary anesthetic and surgical care.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Hadassah - Hebrew University Medical Center, Hebrew University - Hadassah School of Medicine, Jerusalem, Israel.
authors.forename: Rawhi
authors.initials: R
authors.lastname: Hashem
authors.forename: Charles
authors.initials: C
authors.lastname: Weissman
mesh_terms: D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000209:etiology* / Q000517:prevention & control; D019990:Perioperative Care; D059035:Perioperative Period; D011183:Postoperative Complications / Q000517:prevention & control*; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D014882:Water-Electrolyte Balance / Q000502:physiology; D014883:Water-Electrolyte Imbalance / Q000209:etiology* / Q000517:prevention & control