Acute Kidney Injury (AKI) 

 

 

Considerations 

 

  • Higher risk of peri-operative morbidity & mortality 

  • Altered pharmacology 

  • Dysregulation of volume status, acid-base (metabolic acidosis), & electrolytes

 

 

Management 

 

  • Consult nephrology 

  • Avoid further renal insults:  

    • Maintain euvolemia 

    • Maintain adequate renal perfusion: MAP > 65

    • Avoid nephrotoxins: contrast dye, NSAIDs, aminoglycoside antibiotics 

  • Identify & treat underlying cause:

    • Replace intravascular volume 

    • Optimize cardiac output & blood pressure 

    • Correct any outflow obstruction (e.g., BPH) 

    • Stop nephrotoxic medications  

  • Know indications for hemodialysis: 

    • Acidosis 

    • Electrolyte disturbances (↑ K) 

    • Intoxication (e.g. methanol, ethylene glycol) 

    • Volume overload 

    • Uremia 

 

 

Conflicts

 

  • RSI with succinylcholine vs. high K+ 

  • Need for contrast vs. AKI 

  • Need for surgery vs. AKI