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. 2021 Mar;68(3):409-422.
doi: 10.1007/s12630-020-01894-z. Epub 2021 Jan 6.

The incidence, risk, presentation, pathophysiology, treatment, and effects of perioperative acute kidney injury

Frederic T Billings 4th  1 , Marcos G Lopez  2 , Andrew D Shaw  3
Affiliations

The incidence, risk, presentation, pathophysiology, treatment, and effects of perioperative acute kidney injury

Frederic T Billings 4th et al. Can J Anaesth. 2021 Mar.

Abstract
in English, French

Purpose: Present clinical updates, current research findings, and consensus statements relevant to the care of the acute kidney injury (AKI) patient.

Principal findings: Acute kidney injury is one of the most frequent and debilitating complications of surgery and critical illness. Consensus criteria use serum creatinine and urine output measurements to diagnose AKI and allow for objective diagnosis and more accurate comparisons across populations. New serum and urine biomarkers may provide earlier evidence of AKI, but their clinical utility, while increasing, remains limited. Avoidance of nephrotoxins, intravascular fluid management, and maintenance of renal perfusion are the mainstays of preventive management and treatment of AKI. Optimal timing for the initiation of renal replacement therapy is controversial and remains under investigation.

Conclusions: Acute kidney injury continues to affect large numbers of patients receiving surgery or in the intensive care unit, but specific advances in resuscitation techniques, endpoint refinements, epidemiology, biomarkers, and pathology are providing the necessary framework to reduce AKI and associated morbidity.

RéSUMé: OBJECTIF: Présenter les mises à jour cliniques, les résultats de recherche actuels et les énoncés de consensus pertinents concernant les soins des patients atteints d’insuffisance rénale aiguë (IRA). CONSTATATIONS PRINCIPALES: L’insuffisance rénale aiguë est l’une des complications les plus fréquentes et débilitantes de la chirurgie et des maladies critiques. Les critères consensuels se fondent sur des mesures de la créatininémie et de la diurèse pour diagnostiquer l’IRA et favorisent un diagnostic objectif et des comparaisons plus précises entre les populations. Les nouveaux biomarqueurs sériques et urinaires pourraient permettre une identification précoce de l’IRA mais leur utilité clinique, certes croissante, demeure limitée. Les piliers d’une prise en charge et d’un traitement préventif de l’IRA demeurent la minimisation de l’exposition aux néphrotoxines, la gestion liquidienne intravasculaire et le maintien de la perfusion rénale. Le moment optimal pour l’amorce d’un traitement substitutif de l’insuffisance rénale demeure controversé et reste à déterminer. CONCLUSION: L’insuffisance rénale aiguë continue d’affecter un grand nombre de patients recevant une chirurgie ou à l’unité de soins intensifs, mais des progrès spécifiques dans les techniques de réanimation, les indicateurs de résultat, dans l’épidémiologie, les biomarqueurs et la pathologie fournissent le cadre nécessaire pour réduire l’IRA et la morbidité associée.

Keywords: AKI; acute kidney injury; dialysis; perioperative; renal failure; renal replacement therapy; surgery.

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Conflict of interest statement

Conflicts of interest: The authors declare no competing interests.

Figures

Figure.
Figure.
Renal function trajectories in patients who do and do not suffer acute kidney injury (AKI) and do and do not progress to chronic kidney disease (CKD).
See this image and copyright information in PMC

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