PERIOPERATIVE ACUTE KIDNEY INJURY

Abstract

AKI frequnlty occurs in the setting of crtical surgical illness with multiple organ failure (MOF), mortality is alarmingly high (upto 90%), and the mortality rate may be higher for surgical patients than for medical with renal failure. The development of perioperative AKI is associated with prolonged hospital stay and high incidence of morbidity and mortality. The incidence of postoperative AKI varies from 1.1% to 17%. Aortic surgery, coronary artery bypass surgery, renal and liver transplantation and surgery in the presence of obstructive jaundice are known to be independent risk factors for the development of postoperative acute kidney injury. The glomerular filtration rate (GFR) is probably the single most important marker of renal function. The serum creatinine is influenced by factors such as age, sex, muscle mass and diet. It is insensitive to mild-moderate decreases in GFR, which may be reduced by as much as 50% with normal serum creatinine. Creatinine clearance may be used clinically to estimate GFR, but this usually requires a 24 hour urine collection. Recent interest has focused on proteincystatin C, in contrast to creatinine clearance, the reference range values for cystati C are identical for me, women and children, and are not influenced by muscle mass. An anesthesiologist's main objective for perioperative renal protection is prevention of renal dysfunction by identification of patients who are at risk, maintenance of euvolemia, preservation of adequate renal perfusion, avoidance of nephrotoxins; and pharmacological prophylaxis. The principle task in the early management of oliguric patient to identify and correct volume deficits and discontinue any drugs that coud be a source of oliguric renal failure.