Intended for healthcare professionals

Clinical Review

Perioperative acute kidney injury: risk factors, recognition, management, and outcomes

BMJ 2010; 341 doi: (Published 05 July 2010) Cite this as: BMJ 2010;341:c3365
  1. Emma Borthwick, specialist registrar1,
  2. Andrew Ferguson, consultant in intensive care medicine and anaesthesia2
  1. 1Nephrology and Intensive Care Medicine, Belfast City Hospital, Belfast BT12 7BA
  2. 2Craigavon Area Hospital, Portadown BT63 5QQ
  1. Correspondence to: A Ferguson fergua{at}

    Summary points

    Perioperative acute kidney injury (AKI) is common but poorly recognised and managed

    Perioperative AKI increases surgical mortality and morbidity and increases cost

    An apparently successful surgical outcome may not mean a successful renal outcome

    Careful and thoughtful preoperative assessment, including identifying patients with existing chronic kidney disease and stopping and avoiding nephrotoxic drugs, will reduce the incidence of perioperative AKI.

    Management of AKI centres on optimising fluid status and blood pressure, treating sepsis, and removing nephrotoxic agents where possible

    Patients with AKI are often complex to treat, and senior help should be sought at an early stage

    Acute kidney injury (AKI), formerly known as “acute renal failure,” is associated with increased morbidity, mortality, duration of hospital stay, and healthcare cost.w1 Despite this, published data on perioperative acute kidney injury, occurring between the time of admission for surgery and the time of discharge, are scarce outside the cardiovascular surgery setting. Regardless of the clinical setting, the diagnosis of AKI is often delayed, and treatment is suboptimal in a large proportion of cases.1 To improve diagnosis and treatment, clinicians need to understand the risks and triggers for perioperative AKI, the association of even small transient rises in creatinine concentration with risk of death,2 and what actions they need to take promptly on diagnosis. The term acute kidney injury reflects the importance of thinking of the condition as a spectrum or continuum of disease that may be recognised at an early stage, rather than as an “all or nothing” phenomenon as implied by the term acute renal failure. Recognising earlier stages of renal impairment allows for early appropriate action that may interrupt a process of functional decline.

    In this article we recommend the introduction of systems to ensure that changes in creatinine concentration from baseline are urgently highlighted to the …

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