Management of post-operative acute kidney injury.
Post-operative acute kidney injury (AKI) is a common complication of surgery with significant short- and long-term adverse consequences. The adoption of diagnostic criteria for AKI (RIFLE, AKIN and KDIGO) has facilitated comparison of data reported by different centres, confirming that even mild AKI is associated with excess mortality. It remains unclear whether this is caused by the kidney injury itself or whether AKI is simply a marker of underlying disease severity. There is no trial evidence to support the use of any specific therapeutic intervention in post-operative AKI. Best current treatment is, therefore, preventative by optimizing hydration and avoidance of nephrotoxins, emphasizing the importance of earlier detection and identification of individuals at high risk for AKI. In this review, we examine the latest literature on the management of post-operative AKI in adult patients, specifically the diagnosis and definition of AKI, epidemiology and pathogenesis and risk stratification in cardiac and non-cardiac surgery. We also review the latest evidence on pharmacological and non-pharmacological interventions.
Renal Unit, Ninewells Hospital, Dundee DD1 9SY, Scotland.
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S
Bell
Renal Unit, Ninewells Hospital, Dundee DD1 9SY, Scotland.
V C
VC
Ross
Department of Anaesthetics, Ninewells Hospital, Dundee DD1 SY, Scotland.
K A
KA
Zealley
Department of Anaesthetics, Ninewells Hospital, Dundee DD1 SY, Scotland.
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F
Millar
Renal Unit, Dumfries and Galloway Royal Infirmary, Dumfries, Scotland.
C
C
Isles
D058186:Acute Kidney Injury / Q000628:therapy*; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000628:therapy*; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index