Renal complications of anaesthesia

Abstract

SummaryPeri-operative acute kidney injury is common, accounting for 30-40% of all in-hospital cases of acute kidney injury. It is associated with clinically significant morbidity and mortality even with what was hitherto regarded as relatively trivial increases in serum creatinine, and carries over a 12-fold relative risk of death following major abdominal surgery. Comorbid conditions such as diabetes, hypertension, liver disease and particularly pre-existing chronic kidney disease, as well as the type and urgency of surgery, are major risk factors for the development of postoperative acute kidney injury. As yet, there are no specific treatment options for the injured kidney, although there are several modifiable risk factors of which the anaesthetist should be aware. As well as the avoidance of potential nephrotoxins and appropriate volume balance, optimal anaesthetic management should aim to reduce the risk of postoperative renal complications. This may include careful ventilatory management and blood pressure control, as well as appropriate analgesic strategies. The choice of anaesthetic agent may also influence renal outcomes. Rather than concentrate on the classical management of acute kidney injury, this review focuses on the potential development of acute kidney injury peri-operatively, and the means by which this may be ameliorated.

L-Arginine/NO Pathway Metabolites in Colorectal Cancer: Relevance as Disease Biomarkers and Predictors of Adverse Clinical Outcomes Following Surgery

“…It is possible that such altered filtration in the early postoperative period hampers SDMA excretion, leading to metabolite accumulation in the blood. Acute kidney injury (AKI) is a relatively common complication after colorectal surgery [49], more so in males and patients with transfusions [48], with which, as shown here, the SDMA increase at 24 h post incision was positively correlated. In fact, SDMA has been proposed as a marker of renal function in children with nephrotic syndrome [50] and adults with chronic kidney disease [51].…”

“…The pool of dimethylarginines is regulated by the rate of their synthesis as well as degradation, which includes renal excretion and enzymatic degradation to citrulline and DMA in the case of ADMA but solely renal excretion in the case of SDMA [ 11 ]. The anesthesia during surgery, blood loss, surgery-induced increase in aldosterone and antidiuretic hormone, and electrolyte imbalance associated with bowel manipulation and postoperative ileus may impair the renal function [ 48 , 49 ]. It is possible that such altered filtration in the early postoperative period hampers SDMA excretion, leading to metabolite accumulation in the blood.…”

Relationship between perioperative thyroid function and acute kidney injury after thyroidectomy

“…The prevalence of underlying diabetes mellitus was higher in the AKI group, but it showed no statistical relationship with AKI following multivariable analysis. Diabetes is also known as one of the risk factors of for postoperative AKI; and this association is thought to result from the possibility of pre-existing CKD 43 . This may affect our results because we excluded patients with CKD.…”

If there is a 50‐50 chance that something is correct, then nine times out of ten it will be… Bayesian network meta‐analyses in Anaesthesia

“…Not only can different strategies improve efficacy by superimposing their effects but they may even be synergistic, although it should be recognised that this is not a precondition and there is also potential for antagonism. Approximately 40% of in‐hospital cases of postoperative acute kidney injury (AKI) are related to surgical procedures and the incidence is particularly high after cardiac surgery. Subsequent morbidity and mortality is also high and treatment can be prolonged and expensive, so it is not surprising that much effort has been directed to prevention.…”