title: Therapy of acute kidney injury in the perioperative setting.
abstract: OBJECTIVE
  The current review analyzes the current pharmacologic approaches in cardiac surgery-associated acute kidney injury and renal replacement/support therapies.
  
  
  RESULTS
  Hemodynamic management and promising therapies, including atrial natriuretic peptide, calcium sensitizer inodilators, and mesenchymal stem cells have been discussed. Encouraging results from pre-emptive renal replacement therapies have been also addressed.
  
  
  CONCLUSIONS
  Cardiac surgery is responsible for the highest risk of renal dysfunction with respect to other surgical settings. A number of different and coacting insults, including toxins, renal hypoperfusion, ischemia-reperfusion injury, and systemic inflammation, are leading causes of this frequent complication. Intense research is ongoing on the treatment of established cardiac surgery-associated acute kidney injury and, in this view, a holistic approach including preoperative data, risk stratification, prevention, timely diagnosis, and aggressive intervention can limit the burdening consequences of renal dysfunction in these patients. Although no specific pharmacologic and nonpharmacologic strategy can be currently recommended outside clinical research, the prompt identification of renal dysfunction and the application of multimodal treatments are fundamental aspects. Right ventricular dysfunction and increased central venous pressure, frequently affecting cardiac surgery patients, potentially lead to congestive renal dysfunction. Hemodynamic management covers a central role in these cases.
authors.affiliation: aDepartment of Health Science, Section of Anaesthesiology and Intensive Care, University of Florence bDepartment of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence cDepartment of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome dDepartment of Nephrology, Dialysis and Transplantation eInternational Renal Research Institute, San Bortolo Hospital, Vicenza, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Romagnoli
authors.forename: Zaccaria
authors.initials: Z
authors.lastname: Ricci
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy*; D009320:Atrial Natriuretic Factor / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D000077324:Crystalloid Solutions; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use; D019990:Perioperative Care / Q000379:methods* / Q000592:standards; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D017582:Renal Replacement Therapy / Q000379:methods / Q000592:standards; D013997:Time Factors
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D009320:Atrial Natriuretic Factor