Management of post-operative acute kidney injury

TY - JOUR

T1 - Management of post-operative acute kidney injury

AU - Bell, Samira

AU - Ross, Victoria C.

AU - Zealley, Katherine A.

AU - Millar, Fergus

AU - Isles, Chris

N1 - This work was supported by the Chief Scientist Office for Scotland through an NHS Research Scotland Fellowship.

PY - 2017/11

Y1 - 2017/11

N2 - Post-operative Acute Kidney Injury (AKI) is a common complication of surgery with significant short and long term adverse consequences. The adoption of diagnostic criteria for AKI (RIFLE, AKIN, KDIGO) has facilitated comparison of data reported by different centres, confirming that even mild AKI is associated with excess mortality. It remains unclear whether this is caused by the kidney injury itself or whether AKI is simply a marker of underlying disease severity. There is no trial evidence to support the use of any specific therapeutic intervention in post-operative AKI. Best current treatment is therefore preventative by optimising hydration and avoidance of nephrotoxins, emphasising the importance of earlier detection and identification of individuals at high risk for AKI. In this review, we examine the latest literature on the management of post-operative AKI in adult patients, specifically the diagnosis and definition of AKI, epidemiology and pathogenesis and risk stratification in cardiac and non- cardiac surgery. We also review the latest evidence on pharmacological and non- pharmacological interventions.

AB - Post-operative Acute Kidney Injury (AKI) is a common complication of surgery with significant short and long term adverse consequences. The adoption of diagnostic criteria for AKI (RIFLE, AKIN, KDIGO) has facilitated comparison of data reported by different centres, confirming that even mild AKI is associated with excess mortality. It remains unclear whether this is caused by the kidney injury itself or whether AKI is simply a marker of underlying disease severity. There is no trial evidence to support the use of any specific therapeutic intervention in post-operative AKI. Best current treatment is therefore preventative by optimising hydration and avoidance of nephrotoxins, emphasising the importance of earlier detection and identification of individuals at high risk for AKI. In this review, we examine the latest literature on the management of post-operative AKI in adult patients, specifically the diagnosis and definition of AKI, epidemiology and pathogenesis and risk stratification in cardiac and non- cardiac surgery. We also review the latest evidence on pharmacological and non- pharmacological interventions.

U2 - 10.1093/qjmed/hcw175

DO - 10.1093/qjmed/hcw175

M3 - Article

C2 - 27803367

SN - 1460-2725

VL - 110

SP - 695

EP - 700

JO - QJM : an International Journal of Medicine

JF - QJM : an International Journal of Medicine

IS - 11

ER -