Postoperative Acute Renal Failure

Frequency

Predisposing Factors

Preventive Strategies

Elective surgery 1%-5% Emergent or vascular surgery 5%-10%

Comorbidity results in decreased renal reserve The surgical experience decreases renal function (volume shifts, vasoconstriction) A second insult usually occurs (sepsis, reoperation, nephrotoxin, volume/cardiac issue)

Avoid nephrotoxins

Minimize hospital-acquired infections

(invasive equipment) Selective use of volume expansion, vasodilators, inotropes Preoperative hemodynamic optimization in selected cases Increase tissue oxygenation delivery to supranormal levels in selected cases

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