Periop management

Question 1

What are risk factors for perioperative AKI

How will you prevent these?

Answer 1

KDIGO criteria = >50% serum creatinine rise in 7 days or <0.5ml/kg/hr urine for 6 hours

Stage 1 = creatinine 1.5-1.9xbaseline / UO <0.5ml/kg/hr 6-12hr
Stage 2 = creatinine 2-2.9x basline / UO <0.5ml/kg/hr 12-24hrs
Stage 3 = creatinine 3x basline / UO <0.3ml/kg/hr 24 hrs or anuric for 12 hours or RRT

RISK
Patient - established CKD
Older Age
Unwell eg sepsis
Nephrotoxics eg NSAIDs contrast
Surgery - Surgery involving clamping aorta eg AAA, bypass 
Prolonged surgery 
Hypotension

B)
Establish their risk
If AKI consider delaying non essential surgery
Stop nephrotoxics and dont give NSAIDs
Correct hypovolaemia aim euvolamiea
Maintain renal blood flow avoid hypotension
Minimise aortic clamp time
Minimise contrast load
No evidence for NAC, frusemide, mannitol, diuretics
Post op
Monitor UEC / UO - avoid hypotension
Higher risk consider HDU
Early renal involvement