Perioperative Kidney Dysfunction and Protection

Perioperative acute renal failure is a common complication of major surgery and is associated with increased morbidity and mortality.
Ischaemia- or toxin-mediated acute tubular necrosis is the primary cause of perioperative acute renal failure.
The key non-pharmacological strategies are intravascular volume expansion, maintenance of renal blood flow and renal perfusion pressure, avoidance of nephrotoxic agents, careful glycaemic control, and the appropriate management of post-operative complications.
At present, there is no firm evidence to suggest that the use of any specific pharmacological intervention is clinically beneficial.
Dopamine infusion has not been shown to prevent acute renal failure, avert the need for renal replacement therapy, or reduce mortality, and should not be administered solely for renal protection.

Contin Educ Anaesth Crit Care Pain (2008) 8 (5): 176-180

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