KEY POINTS
- Perioperative ARF, although uncommon, is associated with extremely high
morbidity and mortality rates.
- The mechanism for perioperative ARF is complex and multifactorial but essentially
can be characterized as hemodynamically mediated renal failure.
- Direct assessment of renal hemodynamics, tubular function, or pathogenesis
of perioperative renal dysfunction is difficult and not practical; therefore, indirect
assessments must be used.
- Intraoperative urine formation depends on a number of factors and is an
insensitive and unreliabl method for assessing postoperative risk of renal dysfunction
outcome.
- Serum chemistries and urine indices such as BUN, creatinine, fractional
excretion of sodium, and free water clearance are generally late indicators of renal
function deterioration and do not enable the clinician to clearly delineate the cause
of renal failure.
- Creatinine clearance is the most sensitive and specific method for determining
renal risk, but it is limited by time and measurement restrictions.
- Biochemical markers for renal function hold promise for differentiating
glomerular from tubular causes but remain primarily limited to research settings.
- Promising new technologies such as urine oximetry, ultrasound techniques,
and radiopharmaceutical methods are being explored and may provide assessment of
renal function in the operating room or critical care environment in the near future.
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