Perioperative Acute Kidney Injury: Diagnosis and Management-References

References

Pdf Summary

The document compiles extensive references on perioperative acute kidney injury (AKI), covering its diagnosis, risk factors, prevention, and management from 2015 to 2024. Key themes include the classification and definition of AKI using standardized criteria such as RIFLE, AKIN, and KDIGO, which are pivotal in assessing AKI severity and prognosis. The clinical relevance of these classifications is supported by studies demonstrating their predictive value for outcomes, particularly in cardiac and noncardiac surgeries.<br /><br />Perioperative AKI is identified as a significant, often under-recognized complication associated with increased mortality, length of hospital stay, and healthcare costs. Risk factors include preexisting renal dysfunction, type of surgery (notably cardiac and orthopedic), intraoperative hypotension, anemia, fluid management strategies, and use of nephrotoxic agents. Various clinical scores and risk indices have been developed and validated to predict AKI risk in surgical patients.<br /><br />Prevention strategies discussed emphasize optimization of hemodynamics, careful fluid management, avoidance of nephrotoxic drugs, and maintaining adequate oxygen delivery and renal perfusion. Pharmacologic interventions with mixed evidence include statins, fenoldopam, and dexmedetomidine, which have been investigated for their renal protective effects in the perioperative setting. Conversely, diuretics and low-dose dopamine have not consistently demonstrated benefits and may be harmful.<br /><br />Diagnostic approaches involve clinical assessment, laboratory biomarkers (e.g., fractional excretion of sodium and urea), and imaging modalities like renal ultrasonography for risk stratification. The role of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers perioperatively remains controversial, with some evidence advising against their continuation before major surgery due to hypotension risk.<br /><br />Overall, the references highlight the complexity of perioperative AKI management, the importance of early identification through validated criteria, and the need for individualized preventive and therapeutic strategies to improve patient outcomes.

Keywords

Perioperative acute kidney injury

AKI diagnosis

RIFLE criteria

AKIN criteria

KDIGO guidelines

Risk factors for AKI

Prevention of perioperative AKI

Renal protective pharmacologic agents

Biomarkers for AKI

Management of perioperative AKI