Perioperative Acute Kidney Injury

AKI is common and is associated with many adverse perioperative outcomes. Mild to moderate AKI is much more common than severe AKI and has become much more appreciated with the introduction of consensus definitions for AKI. All stages of AKI severity are associated with increased morbidity and mortality. Clinical risk factors for AKI vary in different surgical populations, and preventable risk factors are often underappreciated before surgery. Efforts must focus on better identification of risk factors, better risk stratification and, thus, prediction of AKI in susceptible patients, and ultimately the prevention of AKI if possible or the facilitation of renal recovery in those patients who sustain AKI. Every surgical patient should have a systematic preoperative assessment of kidney health, with an emphasis on patients’ renal reserve and susceptibility to new injury. In the postoperative period the exposure to any intraoperative risk, and the extent of any renal damage, needs to be evaluated using a combination of clinical parameters, novel biomarkers, and evolving imaging techniques. The prompt initiation of treatment and measures to prevent further renal injury, and to promote renal recovery, can then be instituted.