Perioperative acute kidney injury

Area of Science:

• Nephrology
• Anesthesiology
• Critical Care Medicine

Background:

• Perioperative acute kidney injury (AKI) is a significant clinical problem associated with high morbidity and mortality.
• Existing AKI definitions use serum creatinine and urine output; novel biomarkers are being explored.
• Patient comorbidities and surgical factors, including emergency/major surgery and specific procedures (cardiac, transplantation), increase AKI risk.

Purpose of the Study:

• To review risk factors and preventive strategies for perioperative AKI.
• To highlight the role of comorbidities, surgical interventions, and nephrotoxic agents in AKI development.
• To discuss anesthetic and surgical management aimed at mitigating AKI risk.

Main Methods:

• Review of current literature on perioperative AKI.
• Analysis of diagnostic criteria and emerging biomarkers for AKI.
• Discussion of anesthetic and surgical management principles for AKI prevention.

Main Results:

• Nephrotoxic drugs, contrast media, and diuretics contribute to in-hospital AKI.
• Preoperative optimization (anemia, hypovolemia) and intraoperative normovolemia are crucial.
• Avoiding hypotension (MAP <55-60 mmHg), minimizing blood loss, and judicious fluid management are key preventive measures.

Conclusions:

• Anesthetists must identify high-risk patients and optimize their condition preoperatively.
• Intraoperative management should focus on maintaining adequate blood pressure and minimizing renal insults.
• Careful consideration of fluid administration, blood transfusions, and nephrotoxic agents is essential for AKI prevention.