Perioperative Acute Kidney Injury ,
Sam D. Gumbert, M.D.; Felix Kork, M.D., M.Sc.; Maisie L. Jackson, M.D.; Naveen Vanga, M.D.; Semhar J. Ghebremichael, M.D.; et alChristy Y. Wang, M.D.; Holger K. Eltzschig, M.D., Ph.D.
Author Notes
From the Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas (S.D.G., M.L.J., N.V., S.J.G., C.Y.W., H.K.E.); and the Department of Anesthesiology, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany (F.K.).
Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
S.D.G. and F.K. contributed equally to this article.
Submitted for publication December 6, 2018. Accepted for publication July 26, 2019.
Correspondence: Address correspondence to Dr. Eltzschig: McGovern Medical School at UTHealth, 6431 Fannin Street, MSB 5.182A, Houston, Texas 77030. Holger.Eltzschig@uth.tmc.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Anesthesiology Newly Published on October 25, 2019. doi:10.1097/ALN.0000000000002968
Abstract
Perioperative organ injury is among the leading causes of morbidity and mortality of surgical patients. Among different types of perioperative organ injury, acute kidney injury occurs particularly frequently and has an exceptionally detrimental effect on surgical outcomes. Currently, acute kidney injury is most commonly diagnosed by assessing increases in serum creatinine concentration or decreased urine output. Recently, novel biomarkers have become a focus of translational research for improving timely detection and prognosis for acute kidney injury. However, specificity and timing of biomarker release continue to present challenges to their integration into existing diagnostic regimens. Despite many clinical trials using various pharmacologic or nonpharmacologic interventions, reliable means to prevent or reverse acute kidney injury are still lacking. Nevertheless, several recent randomized multicenter trials provide new insights into renal replacement strategies, composition of intravenous fluid replacement, goal-directed fluid therapy, or remote ischemic preconditioning in their impact on perioperative acute kidney injury. This review provides an update on the latest progress toward the understanding of disease mechanism, diagnosis, and managing perioperative acute kidney injury, as well as highlights areas of ongoing research efforts for preventing and treating acute kidney injury in surgical patients.
Sam D. Gumbert, M.D.; Felix Kork, M.D., M.Sc.; Maisie L. Jackson, M.D.; Naveen Vanga, M.D.; Semhar J. Ghebremichael, M.D.; et alChristy Y. Wang, M.D.; Holger K. Eltzschig, M.D., Ph.D.
Author Notes
From the Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas (S.D.G., M.L.J., N.V., S.J.G., C.Y.W., H.K.E.); and the Department of Anesthesiology, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany (F.K.).
Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
S.D.G. and F.K. contributed equally to this article.
Submitted for publication December 6, 2018. Accepted for publication July 26, 2019.
Correspondence: Address correspondence to Dr. Eltzschig: McGovern Medical School at UTHealth, 6431 Fannin Street, MSB 5.182A, Houston, Texas 77030. Holger.Eltzschig@uth.tmc.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Anesthesiology Newly Published on October 25, 2019. doi:10.1097/ALN.0000000000002968
Abstract
Perioperative organ injury is among the leading causes of morbidity and mortality of surgical patients. Among different types of perioperative organ injury, acute kidney injury occurs particularly frequently and has an exceptionally detrimental effect on surgical outcomes. Currently, acute kidney injury is most commonly diagnosed by assessing increases in serum creatinine concentration or decreased urine output. Recently, novel biomarkers have become a focus of translational research for improving timely detection and prognosis for acute kidney injury. However, specificity and timing of biomarker release continue to present challenges to their integration into existing diagnostic regimens. Despite many clinical trials using various pharmacologic or nonpharmacologic interventions, reliable means to prevent or reverse acute kidney injury are still lacking. Nevertheless, several recent randomized multicenter trials provide new insights into renal replacement strategies, composition of intravenous fluid replacement, goal-directed fluid therapy, or remote ischemic preconditioning in their impact on perioperative acute kidney injury. This review provides an update on the latest progress toward the understanding of disease mechanism, diagnosis, and managing perioperative acute kidney injury, as well as highlights areas of ongoing research efforts for preventing and treating acute kidney injury in surgical patients.
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