Preventing Perioperative Acute Kidney Injury

Abstract

Peri-operative acute kidney injury (AKI) is a feared consequence of surgery and is associated with considerable morbidity and mortality. It has both short and long term deleterious effects. The term AKI is used to describe a rapid deterioration (hours to days) of renal function. The patho-physiology of peri-operative AKI is complex and involves both ischemia and inflammation as causative factors. Recently, several definition systems for AKI were proposed, incorporating both small changes of serum creatinine and urinary output reduction as diagnostic criteria. Urine output does not predict postoperative AKI.[1,2] Despite the continued effort to standardize the definition of AKI using S.Cr, these methods have several flaws. The increase In S.Cr is late in the course of AKI such that by the time the diagnosis is made using standard laboratory methods the disease is well established. In addition, S.Cr can be influenced by volume overload, nutrition, steroids, and muscle trauma.