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Postoperative renal dysfunction after noncardiac surgery

Vaara, Suvi T.a; Bellomo, Rinaldoa,b

Current Opinion in Critical Care: October 2017 - Volume 23 - Issue 5 - p 440–446
doi: 10.1097/MCC.0000000000000439
POSTOPERATIVE PROBLEMS: Edited by Samir Jaber

Purpose of review The narrative review aims to discuss recent results and important knowledge gaps regarding acute kidney injury (AKI) in postoperative patients undergone major noncardiac surgery.

Recent findings Postoperative AKI affects approximately one-fifth of patients after major surgery, but the incidence varies according to the type of surgery. Preexisting chronic kidney disease is a major risk factor for postoperative AKI. It carries a substantial risk for postoperative adverse outcomes, as well as long-term mortality and morbidity. To prevent postoperative AKI, avoiding intraoperative hypotension and hypoperfusion as well as nephrotoxic substances are important. Currently, no efficient pharmacotherapy for prevention or treatment of AKI is available. In general, goal-directed management protocols have reduced the incidence of postoperative AKI. Additionally, a restrictive fluid management regimen might reduce organ edema and be beneficial also for the kidney function.

Summary AKI is a frequent postoperative complication with a substantial risk for both short and long-term adverse events, and its incidence is likely to rise because of increasing major surgical procedures. Studies investigating better strategies to prevent and treat AKI in this population are urgently needed.

aDepartment of Intensive Care, Department of Medicine, Austin Hospital

bThe University of Melbourne, Melbourne, Victoria, Australia

Correspondence to Professor Rinaldo Bellomo, Department of Intensive Care, Department of Medicine, Austin Hospital, Studley Rd, Heidelberg, VIC 3084, Australia. Tel: +61 3 9496 5992; fax: +61 3 9496 3932; e-mail: rinaldo.bellomo@austin.org.au

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