title: Novel therapy for renal protection.
abstract: OBJECTIVE
  Acute kidney injury (AKI) is a common and serious complication that significantly increases morbidity, mortality, and cost of care after surgery. In this article, we review recent studies that deal with strategies for renal protection and the prevention of AKI after surgery.
  
  
  RESULTS
  A prerequisite for any prophylactic intervention is the identification of patients at risk for AKI or those with acute kidney damage before kidney function deteriorates. In this context, new biomarkers can help to detect cellular injury early. This way, a window for interventions can be opened. Several studies demonstrated the tissue-protective effect of remote ischemic preconditioning in various organs. There is clear evidence that use of balanced crystalloid fluids and the avoidance of hyperchloremic solutions for infusion therapy can reduce the incidence of AKI. Preliminary data show a protective effect if dexmedetomidine is used as a sedative agent following cardiac surgery. The most important intervention with proven efficacy to protect from AKI is aggressive hemodynamic stabilization.
  
  
  CONCLUSIONS
  Early identification of patients at risk for AKI is crucial to apply any protective intervention. An improved perioperative management is required to prevent AKI. Although pharmacological therapies aiming to protect AKI are under evaluation, hemodynamic optimization and avoidance of nephrotoxic drugs are critical for perioperative patient.
authors.affiliation: aDepartment of Anesthesiology, Intensive Care, and Pain Medicine, University of Münster, Münster bDepartment of Anesthesiology and Intensive Care Medicine, University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Zarbock
authors.forename: Kindgen
authors.initials: K
authors.lastname: Milles
mesh_terms: D058186:Acute Kidney Injury / Q000517:prevention & control*; D000077324:Crystalloid Solutions; D020927:Dexmedetomidine; D005440:Fluid Therapy; D006801:Humans; D006993:Hypnotics and Sedatives; D019194:Ischemic Preconditioning; D007552:Isotonic Solutions / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control*; D013514:Surgical Procedures, Operative / Q000009:adverse effects*
chemical_list: D000077324:Crystalloid Solutions; D006993:Hypnotics and Sedatives; D007552:Isotonic Solutions; D020927:Dexmedetomidine