SUMMARY

In patients with real or potential renal dysfunction, the perioperative management continues to be challenging. The causes of perioperative ARF vary but typically have a common mechanism of insufficient renal blood flow delivery or acute tubular necrosis, or both.

As our understanding of renal function continues to evolve, traditional answers turn into new questions. The introduction of new agents and the re-exploration of old techniques and their respective influence and reliance on renal function should become clearer with advances in renal function monitoring. Whether this information will modify the prognosis of renal dysfunction is unknown. Meanwhile, we are limited to relying on indirect variables of renal function that may or may not bear a reliable relationship to the GFR and renal blood flow—and therefore renal function—during the perioperative period. In the near future, we may be able to understand susceptibility to renal dysfunction on the basis of genetic screening and understand how to launch effective preventive management strategies by using this monitoring approach.