Peri-operative renal protection: The strategies revisited

Abstract

Postoperative acute renal failure (ARF) is a serious complication which can result in a prolonged hospital stay and a high mortality and morbidity. Underlying renal disease, cardiac diseases, nephrotoxin exposure and renal hypoperfusion are the possible predisposing risk factors which can create a high probability for the development of ARF. The incidence of ARF is highest after major vascular, cardiac and high-risk thoraco-abdominal surgery. Among the various renal protection strategies, adequate peri-operative volume expansion and avoidance of hypovolemia is the most accepted and practiced strategy. Numerous bio-markers of renal injury are used to estimate the presence and extent of renal insult and various new are currently under trial. Traditional pharmacological interventions like dopamine, diuretics and calcium antagonists are not currently the first line of reno-protective agents. The new non-pharmacological and pharmacological methods may improve outcome in renal transplantation, contrast-induced nephropathy and in various other settings of ARF. The current review is an attempt to refresh the knowledge and put forth the various renal protection strategies during the peri-operative period.

Adenovirus-Mediated Over-Expression of Nrf2 Within Mesenchymal Stem Cells (MSCs) Protected Rats Against Acute Kidney Injury

“…depletion, loss of cell polarity, and cell-cell and cellmatrix attachment are the consequences of ischemia. [50][51][52][53][54][55] These morphologic changes have been also seen in cisplatin treated rats. Because of the beneficial therapeutic effect of MSCs, morphological abnormalities decreased in Ad-MSCs rats.…”

Acute kidney injury following orthotopic liver transplantation: incidence, risk factors, and effects on patient and graft outcomes

“…Maintaining cardiovascular stability is vital to renal perfusion, but this can be a difficult task during OLT and relying on vasopressors can contribute to the problem. The use of pharmacological agents to protect the kidneys was first studied with dopamine and fenoldopam, 31 but this has proven to be unhelpful. The vasopressin analogue terlipressin has been shown to significantly improve renal function as well as reduce portal pressure while maintaining haemodynamic stability.…”

Anesthetic management of primary hyperparathyroidism: A role rarely noticed and appreciated so far

“…[27] Renal protection strategies should be employed during peri-op period and should continue in post-op period as well. [11] One big concern during parathyroid surgery is the delay caused by frozen section examination for which anesthesia has to be maintained for unduly long periods.…”

“…[910] Renal scans and ultrasound are sometimes carried out for diagnosis of renal stones which is very useful for the formulation and planning for peri-operative renal protection strategies when the patient is administered anesthesia. [1112]…”