Preservation of Renal Function
Acute kidney injury (AKI) remains a frequent and serious complication of surgical procedures and critical illness that is consistently associated with worse outcomes and increased long-term morbidity and mortality. Much work has gone into finding kidney protective measures with disappointingly few therapeutic options available to prevent or to treat AKI. Research has defined some effective kidney protective practices and the purpose of this chapter is to help the clinician to differentiate better clinical practices that are either ineffective, detrimental, or protective to the kidney. The chapter will first provide an introduction to kidney physiology with particular focus on areas that make it vulnerable to injury. The chapter will then shift focus to diagnosis of kidney injury including definitions and early biomarkers that can help risk stratify patients. Then, specific mechanisms of postoperative and critical illness-associated kidney injury will be outlined. The rest of the chapter will review evidence from renal-protective research studies pertinent to the preoperative, intraoperative, and postoperative periods. After reading this chapter, the clinician should have a more robust framework for adoption (mostly avoidance) of renal protective practices (stratified based on level of evidence available) to guide their clinical practice.
