[Current status of renoprotective procedures in the surgery of impaired kidneys]

Renoprotective measures are of utmost importance for the preservation of renal function and prevention of acute renal failure of kidneys with impaired function subjected to operative procedures. Preoperatively a thorough nephrological work-up and preparation of the patient has to be performed. Potentially nephrotoxic drugs should be avoided. Examinations with radio contrast agents may lead to a deterioration of renal function, especially if risk factors are present. Hydration is an important part of preoperative renoprotection. Intraoperative renoprotective measures include atraumatic surgical techniques with preservation of renal parenchyma, the administration of diuretics and dopamine as well as a balanced substitution of blood and fluid loss. If the renal circulation has to be interrupted hypothermia should be applied. Controversy exists concerning the beneficial effect of membrane stabilisers, metabolic inhibitors and nucleotid precursors. For the prevention resp. treatment of postoperative acute renal failure balanced hydration, diuretics, dopamine and parenteral hyperalimentation have proven to be useful. The use of prophylactic dialysis leads to a reduction of the complications associated with acute renal failure.