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Perioperative Acute Kidney Injury: Diagnosis and Management

Acute kidney injury (AKI) is an important complication following cardiac and noncardiac surgery. Up to 18% of hospitalized patients develop AKI, and those who are critically ill have an even higher risk. Comparatively, the incidence of AKI in the perioperative period is 18-47%. Patients with even modest increases in their serum creatinine have increases in their mortality, morbidity, length of stay, and hospital costs. Perioperative AKI is associated with an increased risk of sepsis, anemia, coagulopathy, and mechanical ventilation. Notably, mortality is higher in patients with perioperative AKI even after complete renal recovery. Perioperative AKI correlates with type of surgical procedure, patient characteristics, volume status, hemodynamics, and exposure to nephrotoxins. Presurgical risk stratification and early risk mitigation is extremely important to avoid injury and need for renal replacement therapy (RRT). The following module defines perioperative AKI, identifies specific risk factors and tools for risk stratification, provides an overview of the workup of perioperative AKI, and evaluates various renal protective strategies that can be implemented during this high-risk period.

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