Preoperative renal considerations

airway assessment fluid balance haemodynamic renal Jul 03, 2025

Under pressure: preventing AKI in the operating suite ๐Ÿ’ง๐Ÿฉบ

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:

๐Ÿ”น Definition of AKI

AKI is defined by any of the following:

๐Ÿ“ˆ Increase in serum creatinine (SCr) by ≥0.3โ€ฏmg/dL within 48 hours

๐Ÿ“ˆ Increase in SCr to ≥1.5× the patient’s baseline within the previous 7 days

๐Ÿšซ Urine volume <0.5โ€ฏmL/kg/h for 6 hours

๐Ÿ”น Risk Assessment and Prevention

Patients at risk include those with CKD, diabetes, hypertension, or recent exposure to nephrotoxic agents ๐Ÿ’Š

Preventive measures:
๐Ÿ”ธ Optimise haemodynamic status
๐Ÿ”ธ Ensure adequate hydration
๐Ÿ”ธ Minimise nephrotoxin exposure

For procedures involving contrast:
๐Ÿ”ธ Use the lowest dose possible
๐Ÿ”ธ Ensure hydration before and after the procedure

๐Ÿ”น Monitoring

๐Ÿงช Close monitoring of serum creatinine (SCr)

๐Ÿšฝ Strict tracking of urine output and fluid balance

๐Ÿฉบ Vigilance during post operative recovery, when haemodynamic fluctuations are most likely

๐Ÿ”น Management Strategies

๐ŸŽฏ Address the underlying cause promptly

๐Ÿ’ง Maintain strict fluid and electrolyte balance

โŒ 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 โœ…

Improve Safety โœ…

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

 

Stay connected with news and updates!

Join our mailing list to receive the latest news and updates from our team.
Don't worry, your information will not be shared.

We hate SPAM. We will never sell your information, for any reason.

Want to keep learning?

Want more content like this? Check out our premium membership for exclusive content.ย 

Click Here for Access

ย 

ย 

Join our mailing list for free weekly educational content.

ย 

By entering your details you consent to receiving amazing educational materials and updates about our products and events.