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16 - Effects of Perioperative Management on Kidney Function

from Section 2 - Targeting Effects

Published online by Cambridge University Press:  03 December 2019

Pedro L. Gambús
Affiliation:
Hospital Clinic de Barcelona, Spain
Jan F. A. Hendrickx
Affiliation:
Aalst General Hospital, Belgium
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Summary

Normal kidney function is essential to maintain whole body homeostasis. An acute decline in kidney function, ‘acute kidney injury’ (AKI), is in and by itself a major cause of perioperative morbidity and mortality. Maintaining preexisting kidney function therefore is a key task of the anaesthesiologist in the perioperative period [1].

Studies on perioperative AKI (including worsening of chronic renal failure) have mainly focused on the postoperative/ICU setting because (1) renal dysfunction does not alter intraoperative haemodynamics or oxygenation (provided a neutral fluid balance is maintained); (2) we lack readily available biomarkers to monitor intraoperative renal function (intraoperative oliguria is a poor marker of AKI, and creatinine value takes hours to rise); (3) medical treatment of AKI is mainly performed in the ICU (managing fluid overload, hyperkalaemia, drug dosing adjustments or renal replacement therapies); (4) patients at risk for AKI are likely to be admitted to the ICU postoperatively.

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