Acute renal failure in the surgical setting

Abstract

Acute renal failure (ARF) is an unwelcome complication of major surgical procedures that contributes to surgical morbidity and mortality. Acute renal failure associated with surgery may account for 18-47% of all cases of hospital-acquired ARF. The overall incidence of ARF in surgical patients has been estimated at 1.2%, although is higher in at-risk groups. Mortality of patients with ARF remains disturbingly high, ranging from 25% to 90%, despite advances in dialysis and intensive care support. Appreciation of at-risk surgical populations coupled with intensive perioperative care has the capacity to reduce the incidence of ARF and by implication mortality. Developments in understanding the pathophysiology of ARF may eventually result in newer therapeutic strategies to either prevent or accelerate recovery from ARF. At present the best form of treatment is prevention. In this review the epidemiology, pathophysiology, diagnosis, treatment and possible prevention of ARF will be discussed.

Hypoxia: The Force that Drives Chronic Kidney Disease

“…53 In addition, many forms of surgery where blood flow is inadvertently or deliberately reduced carry an inherent risk for the development of AKI. [62][63][64][65][66][67][68][69][70] Inadvertent surgical reductions in blood flow can be caused by voluminous blood loss such as often occurs during major hepatic resections. 64,69 Deliberate blood flow reduction is caused by the clamping of major blood vessels such as occurs during organ transplantation, cardiopulmonary bypass, and thoracoabdominal aneurysm surgery.…”

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

“…AKI has been divided into pre-renal, renal and post-renal with regards to etiology. In surgical patients, pre-renal etiology, followed by renal etiology, is the most common cause of AKI [23] . As volume changes are common during cardiac surgery, CSA-AKI can be divided into volume responsive and non-volume responsive which usually matches pre-renal and renal etiologies.…”

Residual Urine Output and Postoperative Mortality in Maintenance Hemodialysis Patients

“…The use of prediction equations is as inaccurate as measured clearance in ICU patients in unstable condition 43 ; the only practical measurement is urine volume. 9 Currently, measurement of the amount of urine is more acceptable than other methods used to estimate RRF, especially in ICU patients in unstable condition.…”

“…According to Shemin et al, 5 renal function, as measured by timed urine collections, can have either a beneficial or a protective effect in hemodialysis patients. The role of residual urine output (RUO) in hemodialysis patients is often neglected, and it remains unknown whether the results of survival studies in hemodialysis patients with anuria can be extrapolated to hemodialysis patients who still have RUO after major surgery.Because the amount of urine can be measured accurately in the intensive care unit (ICU), 9 we attempted to gauge RRF by RUO and examined the predictive value of postoperative anuria for ICU mortality among maintenance hemodialysis patients and the difference between postoperative patients with or without anuria. We also constructed a propensity-adjusted logistic regression model to explore the effect of a perioperative change in the amount of urine and other clinical variables on 30-day mortality in postoperative ESRD patients.…”

“…Because the amount of urine can be measured accurately in the intensive care unit (ICU), 9 we attempted to gauge RRF by RUO and examined the predictive value of postoperative anuria for ICU mortality among maintenance hemodialysis patients and the difference between postoperative patients with or without anuria. We also constructed a propensity-adjusted logistic regression model to explore the effect of a perioperative change in the amount of urine and other clinical variables on 30-day mortality in postoperative ESRD patients.…”