A narrative review of the impact of surgery and anaesthesia on acute kidney injury
Summary The epidemiology of peri‐operative acute kidney injury varies depending on the definition, type of surgery and acute and chronic comorbidities. Haemodynamic instability, disturbance of the microcirculation, endothelial dysfunction, inflammation and tubular cell injury are the main factors co...
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| Veröffentlicht in: | Anaesthesia 2020-01, Vol.75 (S1), p.e121-e133 |
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| creator | Ostermann, M. Cennamo, A. Meersch, M. Kunst, G. |
| description | Summary
The epidemiology of peri‐operative acute kidney injury varies depending on the definition, type of surgery and acute and chronic comorbidities. Haemodynamic instability, disturbance of the microcirculation, endothelial dysfunction, inflammation and tubular cell injury are the main factors contributing to the pathogenesis. There are no specific therapies. The most effective strategies to protect renal function during the peri‐operative period are: the avoidance of nephrotoxic insults; optimisation of haemodynamics; prevention of hypotension; and meticulous fluid management, including avoidance of both hypovolaemia and hypervolaemia. Peri‐operative acute kidney injury is associated with an increased risk of short‐ and long‐term postoperative complications, including a longer stay in hospital, development of premature chronic kidney disease and increased mortality. Resource utilisation and healthcare costs are also higher. In future, the development of advanced clinical prediction scores, new imaging and monitoring techniques and the application of new biomarkers for acute kidney injury have the prospect of identifying acute kidney injury earlier and allowing a more personalised management approach with the aim of reducing the global burden of acute kidney injury. |
| doi_str_mv | 10.1111/anae.14932 |
| format | Article |
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The epidemiology of peri‐operative acute kidney injury varies depending on the definition, type of surgery and acute and chronic comorbidities. Haemodynamic instability, disturbance of the microcirculation, endothelial dysfunction, inflammation and tubular cell injury are the main factors contributing to the pathogenesis. There are no specific therapies. The most effective strategies to protect renal function during the peri‐operative period are: the avoidance of nephrotoxic insults; optimisation of haemodynamics; prevention of hypotension; and meticulous fluid management, including avoidance of both hypovolaemia and hypervolaemia. Peri‐operative acute kidney injury is associated with an increased risk of short‐ and long‐term postoperative complications, including a longer stay in hospital, development of premature chronic kidney disease and increased mortality. Resource utilisation and healthcare costs are also higher. In future, the development of advanced clinical prediction scores, new imaging and monitoring techniques and the application of new biomarkers for acute kidney injury have the prospect of identifying acute kidney injury earlier and allowing a more personalised management approach with the aim of reducing the global burden of acute kidney injury.</description><identifier>ISSN: 0003-2409</identifier><identifier>EISSN: 1365-2044</identifier><identifier>DOI: 10.1111/anae.14932</identifier><identifier>PMID: 31903567</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>acute kidney injury ; Acute Kidney Injury - etiology ; anaesthesia ; Anesthesia ; Anesthesia - adverse effects ; Avoidance ; Biomarkers ; Cell injury ; Complications ; Epidemiology ; Fluid management ; Hemodynamics ; Humans ; Hypotension ; Injury prevention ; Kidney diseases ; Kidneys ; Optimization ; Pathogenesis ; peri‐operative ; Postoperative Complications - etiology ; Renal function ; Risk Factors ; Surgery ; Surgical Procedures, Operative - adverse effects</subject><ispartof>Anaesthesia, 2020-01, Vol.75 (S1), p.e121-e133</ispartof><rights>2020 Association of Anaesthetists</rights><rights>2020 Association of Anaesthetists.</rights><rights>Copyright 2019 © Association of Anaesthetists</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3932-8b945c99270e2217231d5fe5a3faf812b9fd2ff52100b74960fa02bcc792fa33</citedby><cites>FETCH-LOGICAL-c3932-8b945c99270e2217231d5fe5a3faf812b9fd2ff52100b74960fa02bcc792fa33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fanae.14932$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fanae.14932$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,1433,27924,27925,45574,45575,46409,46833</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31903567$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ostermann, M.</creatorcontrib><creatorcontrib>Cennamo, A.</creatorcontrib><creatorcontrib>Meersch, M.</creatorcontrib><creatorcontrib>Kunst, G.</creatorcontrib><title>A narrative review of the impact of surgery and anaesthesia on acute kidney injury</title><title>Anaesthesia</title><addtitle>Anaesthesia</addtitle><description>Summary
The epidemiology of peri‐operative acute kidney injury varies depending on the definition, type of surgery and acute and chronic comorbidities. Haemodynamic instability, disturbance of the microcirculation, endothelial dysfunction, inflammation and tubular cell injury are the main factors contributing to the pathogenesis. There are no specific therapies. The most effective strategies to protect renal function during the peri‐operative period are: the avoidance of nephrotoxic insults; optimisation of haemodynamics; prevention of hypotension; and meticulous fluid management, including avoidance of both hypovolaemia and hypervolaemia. Peri‐operative acute kidney injury is associated with an increased risk of short‐ and long‐term postoperative complications, including a longer stay in hospital, development of premature chronic kidney disease and increased mortality. Resource utilisation and healthcare costs are also higher. In future, the development of advanced clinical prediction scores, new imaging and monitoring techniques and the application of new biomarkers for acute kidney injury have the prospect of identifying acute kidney injury earlier and allowing a more personalised management approach with the aim of reducing the global burden of acute kidney injury.</description><subject>acute kidney injury</subject><subject>Acute Kidney Injury - etiology</subject><subject>anaesthesia</subject><subject>Anesthesia</subject><subject>Anesthesia - adverse effects</subject><subject>Avoidance</subject><subject>Biomarkers</subject><subject>Cell injury</subject><subject>Complications</subject><subject>Epidemiology</subject><subject>Fluid management</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Hypotension</subject><subject>Injury prevention</subject><subject>Kidney diseases</subject><subject>Kidneys</subject><subject>Optimization</subject><subject>Pathogenesis</subject><subject>peri‐operative</subject><subject>Postoperative Complications - etiology</subject><subject>Renal function</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Surgical Procedures, Operative - adverse effects</subject><issn>0003-2409</issn><issn>1365-2044</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtOwzAQRS0EoqWw4QOQJTYIKcUe5-VlVJWHhEBC3UdOYoNLHsVOWuXvcZrCggWzGY3m6M6di9AlJXPq6k7UQs6pzxkcoSllYeAB8f1jNCWEMA98wifozNo1IRRiGp-iCaOcsCCMpugtwbUwRrR6K7GRWy13uFG4_ZBYVxuRt8NkO_MuTY9FXeDhmHVrqwVuaizyrpX4Uxe17LGu153pz9GJEqWVF4c-Q6v75Wrx6D2_PjwtkmcvZ86qF2fcD3LOISISgEbAaBEoGQimhIopZFwVoFQAlJAs8nlIlCCQ5XnEQQnGZuhmlN2Y5qtzntJK21yWpahl09kUGGMcAj_gDr3-g66bztTO3J7y45ACOOp2pHLTWGukSjdGV8L0KSXpEHQ6_J7ug3bw1UGyyypZ_KI_yTqAjsBOl7L_RypNXpLlKPoNzRmG1g</recordid><startdate>202001</startdate><enddate>202001</enddate><creator>Ostermann, M.</creator><creator>Cennamo, A.</creator><creator>Meersch, M.</creator><creator>Kunst, G.</creator><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>202001</creationdate><title>A narrative review of the impact of surgery and anaesthesia on acute kidney injury</title><author>Ostermann, M. ; Cennamo, A. ; Meersch, M. ; Kunst, G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3932-8b945c99270e2217231d5fe5a3faf812b9fd2ff52100b74960fa02bcc792fa33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>acute kidney injury</topic><topic>Acute Kidney Injury - etiology</topic><topic>anaesthesia</topic><topic>Anesthesia</topic><topic>Anesthesia - adverse effects</topic><topic>Avoidance</topic><topic>Biomarkers</topic><topic>Cell injury</topic><topic>Complications</topic><topic>Epidemiology</topic><topic>Fluid management</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Hypotension</topic><topic>Injury prevention</topic><topic>Kidney diseases</topic><topic>Kidneys</topic><topic>Optimization</topic><topic>Pathogenesis</topic><topic>peri‐operative</topic><topic>Postoperative Complications - etiology</topic><topic>Renal function</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Surgical Procedures, Operative - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ostermann, M.</creatorcontrib><creatorcontrib>Cennamo, A.</creatorcontrib><creatorcontrib>Meersch, M.</creatorcontrib><creatorcontrib>Kunst, G.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Anaesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ostermann, M.</au><au>Cennamo, A.</au><au>Meersch, M.</au><au>Kunst, G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A narrative review of the impact of surgery and anaesthesia on acute kidney injury</atitle><jtitle>Anaesthesia</jtitle><addtitle>Anaesthesia</addtitle><date>2020-01</date><risdate>2020</risdate><volume>75</volume><issue>S1</issue><spage>e121</spage><epage>e133</epage><pages>e121-e133</pages><issn>0003-2409</issn><eissn>1365-2044</eissn><abstract>Summary
The epidemiology of peri‐operative acute kidney injury varies depending on the definition, type of surgery and acute and chronic comorbidities. Haemodynamic instability, disturbance of the microcirculation, endothelial dysfunction, inflammation and tubular cell injury are the main factors contributing to the pathogenesis. There are no specific therapies. The most effective strategies to protect renal function during the peri‐operative period are: the avoidance of nephrotoxic insults; optimisation of haemodynamics; prevention of hypotension; and meticulous fluid management, including avoidance of both hypovolaemia and hypervolaemia. Peri‐operative acute kidney injury is associated with an increased risk of short‐ and long‐term postoperative complications, including a longer stay in hospital, development of premature chronic kidney disease and increased mortality. Resource utilisation and healthcare costs are also higher. In future, the development of advanced clinical prediction scores, new imaging and monitoring techniques and the application of new biomarkers for acute kidney injury have the prospect of identifying acute kidney injury earlier and allowing a more personalised management approach with the aim of reducing the global burden of acute kidney injury.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>31903567</pmid><doi>10.1111/anae.14932</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals; Free E-Journal (出版社公開部分のみ）; Wiley Online Library Free Content |
| subjects | acute kidney injury Acute Kidney Injury - etiology anaesthesia Anesthesia Anesthesia - adverse effects Avoidance Biomarkers Cell injury Complications Epidemiology Fluid management Hemodynamics Humans Hypotension Injury prevention Kidney diseases Kidneys Optimization Pathogenesis peri‐operative Postoperative Complications - etiology Renal function Risk Factors Surgery Surgical Procedures, Operative - adverse effects |
| title | A narrative review of the impact of surgery and anaesthesia on acute kidney injury |
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