Preoperative renal considerations
Jul 03, 2025
Under pressure: preventing AKI in the operating suite ๐ง๐ฉบ
Acute kidney injury (AKI) is a common and serious postoperative complication, particularly for our vulnerable patients. Perioperative nurses play a critical role in the prevention, detection and management of AKI in collaboration with the broader perioperative team.
As you would expect, there are clinical practice guidelines surrounding the prevention and management of AKIs — the KDIGO (Kidney Disease: Improving Global Outcomes), published by the International Society of Nephrology. Let’s take a closer look:
๐น Definition of AKI
AKI is defined by any of the following:
๐ Increase in serum creatinine (SCr) by ≥0.3โฏmg/dL within 48 hours
๐ Increase in SCr to ≥1.5× the patient’s baseline within the previous 7 days
๐ซ Urine volume <0.5โฏmL/kg/h for 6 hours
๐น Risk Assessment and Prevention
Patients at risk include those with CKD, diabetes, hypertension, or recent exposure to nephrotoxic agents ๐
Preventive measures:
๐ธ Optimise haemodynamic status
๐ธ Ensure adequate hydration
๐ธ Minimise nephrotoxin exposure
For procedures involving contrast:
๐ธ Use the lowest dose possible
๐ธ Ensure hydration before and after the procedure
๐น Monitoring
๐งช Close monitoring of serum creatinine (SCr)
๐ฝ Strict tracking of urine output and fluid balance
๐ฉบ Vigilance during post operative recovery, when haemodynamic fluctuations are most likely
๐น Management Strategies
๐ฏ Address the underlying cause promptly
๐ง Maintain strict fluid and electrolyte balance
โ Avoid additional nephrotoxic exposure
Perioperative nurses are well placed to lead on this front — from pre-op risk assessment, to intraoperative fluid management, and post-op haemodynamic monitoring. Your actions can make all the difference in protecting renal function throughout the perioperative journey.
Build Knowledge โ
Improve Safety โ
Reference:
International Society of Nephrology (2012) KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney international. v2(1) https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2012-AKI-Guideline-English.pdf
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