Anesthesia and acute kidney damage

The review presents modern approaches to managing patients with acute kidney injury during perioperative period. Postoperative acute kidney injury is one of the most serious complications during hospitalization, increasing morbidity, mortality, length of stay in the hospital. The frequency of occurrence of perioperative acute kidney injury depends on the type of surgery and ranges from 0.8% to 94%. The review presents diagnostic criteria and classification of acute kidney injury as recommended by Kidney Disease Improving Global Outcomes (KDIGO). The etiological and pathophysiological substantiation of the development of various forms of acute kidney injury is given. Recommendations are presented for the prevention and treatment of acute kidney injury in the preoperative, intraoperative and postoperative period, formulated from the position of evidence-based medicine. In particular, recommendations on the infusion therapy, control of the volemic status, hemodynamic and nutritional support, the use of diuretics, the prevention of contrast-induced renal damage and the correction of the mode of administration of nephrotoxic drugs are given. The approaches to the initiation and regimens of renal replacement therapy are discussed.