TY  - CHAP
M1  - Book, Section
TI  - Perioperative Management of Kidney Disease
A1  - Cheng, Hugo Q.
A2  - Papadakis, Maxine A.
A2  - McPhee, Stephen J.
A2  - Rabow, Michael W.
PY  - 2021
T2  - Current Medical Diagnosis & Treatment 2021
AB  - Approximately  one-third  of  patients  undergoing  general  surgery  will  suffer  some  degree  of  acute  kidney  injury,  and  3%  of  patients  will  develop  a  creatinine  elevation  greater  than  2  mg/dL  (176.8  mcmol/L)  above  baseline  or  require  renal  replacement  therapy.  The  development  of  acute  kidney  injury  is  an  independent  predictor  of  mortality,  even  if  mild  or  if  kidney  dysfunction  resolves.  The  mortality  associated  with  the  development  of  perioperative  acute  kidney  injury  that  requires  dialysis  exceeds  50%.  Risk  factors  associated  with  postoperative  deterioration  in  kidney  function  are  shown  in  Table  3–8.  Several  medications,  including  “renal-dose”  dopamine,  mannitol,  N-acetylcysteine,  and  clonidine,  have  been  evaluated  in  an  attempt  to  preserve  kidney  function  during  the  perioperative  period.  None  of  these  has  proved  effective  in  clinical  trials  and  should  not  be  used  for  this  indication.  Maintenance  of  adequate  intravascular  volume  is  likely  to  be  the  most  effective  method  to  reduce  the  risk  of  perioperative  deterioration  in  kidney  function.  Exposure  to  renal-toxic  agents,  such  as  nonsteroidal  anti-inflammatory  drugs  and  intravenous  contrast,  should  be  minimized  or  avoided.  Angiotensin-converting  enzyme  inhibitors  and  angiotensin  receptor  blockers  reduce  renal  perfusion  and  may  increase  the  risk  of  perioperative  acute  kidney  injury.  Although  firm  evidence  is  lacking,  it  may  be  useful  to  temporarily  discontinue  these  medications  in  patients  at  risk  for  perioperative  acute  kidney  injury.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2023/01/26
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1175790622
ER  -