Preoperative renal considerations

airway assessment fluid balance haemodynamic renal Jul 03, 2025

Under pressure: preventing AKI in the operating suite 💧🩺

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:

🔹 Definition of AKI

AKI is defined by any of the following:

📈 Increase in serum creatinine (SCr) by ≥0.3 mg/dL within 48 hours

📈 Increase in SCr to ≥1.5× the patient’s baseline within the previous 7 days

🚫 Urine volume <0.5 mL/kg/h for 6 hours

🔹 Risk Assessment and Prevention

Patients at risk include those with CKD, diabetes, hypertension, or recent exposure to nephrotoxic agents 💊

Preventive measures:
🔸 Optimise haemodynamic status
🔸 Ensure adequate hydration
🔸 Minimise nephrotoxin exposure

For procedures involving contrast:
🔸 Use the lowest dose possible
🔸 Ensure hydration before and after the procedure

🔹 Monitoring

🧪 Close monitoring of serum creatinine (SCr)

🚽 Strict tracking of urine output and fluid balance

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

🔹 Management Strategies

🎯 Address the underlying cause promptly

💧 Maintain strict fluid and electrolyte balance

❌ 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 ✅

Improve Safety ✅

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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