Therapy of acute kidney injury in the perioperative setting

Stefano Romagnoli, Zaccaria Ricci, Claudio Ronco

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSE OF REVIEW: The current review analyzes the current pharmacologic approaches in cardiac surgery–associated acute kidney injury and renal replacement/support therapies. RECENT FINDINGS: Hemodynamic management and promising therapies, including atrial natriuretic peptide, calcium sensitizer inodilators, and mesenchymal stem cells have been discussed. Encouraging results from pre-emptive renal replacement therapies have been also addressed. SUMMARY: Cardiac surgery is responsible for the highest risk of renal dysfunction with respect to other surgical settings. A number of different and coacting insults, including toxins, renal hypoperfusion, ischemia–reperfusion injury, and systemic inflammation, are leading causes of this frequent complication. Intense research is ongoing on the treatment of established cardiac surgery–associated acute kidney injury and, in this view, a holistic approach including preoperative data, risk stratification, prevention, timely diagnosis, and aggressive intervention can limit the burdening consequences of renal dysfunction in these patients. Although no specific pharmacologic and nonpharmacologic strategy can be currently recommended outside clinical research, the prompt identification of renal dysfunction and the application of multimodal treatments are fundamental aspects. Right ventricular dysfunction and increased central venous pressure, frequently affecting cardiac surgery patients, potentially lead to congestive renal dysfunction. Hemodynamic management covers a central role in these cases.

Original languageEnglish
JournalCurrent Opinion in Anaesthesiology
DOIs
Publication statusAccepted/In press - Nov 10 2016

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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