Perioperative renal protection

AKI is the term to describe an abrupt reduction in kidney function and it replaces all previous terms such as ARF. The new definition for AKI needs to be validated by future research. Further development of biomarkers of AKI may aid in the early diagnosis and treatment of the syndrome. Mortality due to perioperative AKI often exceeds 50% and small changes in SCr correlate to significant increases in mortality. Preoperative risk factors for the development of AKI include a past history of renal dysfunction, elevated SCr, decreased cardiac performance, and cardiac and vascular surgery. Perioperative renal protection should focus on maintenance of euvolemia, preservation of adequate renal perfusion, and avoidance of any nephrotoxins. Intraoperative fluid management should be titrated to hemodynamic parameters and UO while avoiding excess fluid administration. The ideal fluid to administer is unknown as crystalloids and colloids each have their own advantages and disadvantages. Renal perfusion should be maintained by keeping MAP >65 mmHg and research may identify new techniques to monitor and individualize therapy to maintain renal perfusion. Recent data suggest that fenoldopam may alter outcome in patients with AKI.