Postoperative acute kidney injury.
10.4097/kjae.2017.70.3.258
- Author:
Jung Tak PARK
1
Author Information
1. Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea. JTPARK@yuhs.ac
- Publication Type:Multicenter Study ; Review
- Keywords:
Acute kidney injury;
Postoperative complications;
Renal protection;
Surgery
- MeSH:
Acute Kidney Injury*;
Biomarkers;
Creatinine;
Heart Failure;
Hemodynamics;
Homeostasis;
Humans;
Incidence;
Inflammation;
Obesity;
Postoperative Complications;
Renal Replacement Therapy;
Resuscitation;
Risk Factors;
Thoracic Surgery
- From:Korean Journal of Anesthesiology
2017;70(3):258-266
- CountryRepublic of Korea
- Language:English
-
Abstract:
Acute kidney injury (AKI) after cardiac surgery is a common and serious complication. Several definitions of AKI have been proposed recently, and include both increases in serum creatinine levels and decreases in urine output as diagnostic criteria. The pathophysiology of postoperative AKI is complex and involves both ischemic injury and systemic inflammation. Identifying risk factors, such as old age, underlying diabetes, heart failure, and obesity, may aid in the application of preventative methods for postoperative AKI. Additionally, recognizing different risks after different types of surgical procedures would be valuable. Novel biomarkers that could detect AKI more precisely at an earlier time point are being investigated. Several new biomarkers have been assessed in large multi-center studies and are believed to accommodate conventional clinical findings in diagnosing postoperative AKI. In high-risk patients, preventative measures, such as the maintenance of adequate hemodynamics and sufficient fluid resuscitation, could lower the incidence of postoperative AKI. Avoiding nephrotoxic agents and optimizing preoperative hemoglobin levels to avoid excessive transfusions would also be beneficial. In situations in which medical management fails to maintain sufficient urine output and acid–base and electrolyte homeostasis, early initiation of renal replacement therapy should be considered.
