Globally, more than 10 million people are affected every year by acute kidney injury (AKI) and approximately 6% of hospital patients sustain some degree of kidney injury during their hospital event. Reducing perioperative kidney injury may significantly improve patient outcomes. As perioperative physicians, we are in a position to have some influence on renal outcomes.This article is a review of the current literature on the relevance of renal protection, definitions, mechanisms and new biomarkers of AKI, as well as improved renal perfusion strategies. It specifically considers the renal effects of general and regional anaesthesia, intra-abdominal pressure and abdominal compartment syndrome. The usefulness of certain drugs is investigated. Mechanisms of injury by nephrotoxins, as well as strategies to minimise these injuries, are discussed. Intravenous fluids are briefly mentioned as they relate to renal function.

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