Perioperative care of the renal patient
P. S. Kellerman
Division of Nephrology, University of California-Davis Medical Center, Sacramento.
Due to the hormonal and hemodynamic alterations inherent in the surgical
experience, acute renal failure is common during the perioperative period.
Acute renal failure occurs in 5% of hospital admissions, and the surgical
setting is the second most common cause of inpatient acute renal failure.
Because this setting has the highest mortality for acute renal failure,
recognition of high-risk patients is essential for careful monitoring and
prophylactic measures. Patients with chronic renal insufficiency, elderly
patients, jaundiced patients, diabetics, and those undergoing cardiac or
aortic surgery are at greatest risk for perioperative acute renal failure.
Patients with severe chronic renal failure or end-stage renal disease are
at significant risk for development of complications during the
perioperative period, due both to renal and nonrenal reasons. Hyperkalemia,
infections, arrhythmias, and bleeding commonly occur in these patients
during the perioperative period. This population has a reasonable surgical
mortality for both general and cardiac surgery, but the extremely high
morbidity warrants careful perioperative monitoring and care.
