Perioperative Renoprotection: Clinical Implications

Khaschayar Saadat-Gilani, MD; Alexander Zarbock, MD; Melanie Meersch, MD


Anesth Analg. 2020;131(6):1667-1678. 

In This Article


AKI is still an underrecognized but severe clinical condition and needs to be focused on in daily clinical practice to reduce adverse outcomes. The pathophysiology is complex, and its prevention requires an individualized approach. At this stage, preemptive implementation of bundled interventions, guided by urinary biomarkers, seems the most promising strategy. The early detection of AKI with the use of new renal stress markers is gaining more importance. Hemodynamic optimization, adequate fluid therapy to maintain organ perfusion, and avoiding hyperglycemia play a pivotal role, and attention to these issues as well as risk–benefit assessment of nephrotoxic substances should be considered in daily clinical practice. Individualized thresholds according to the patients underlying comorbidities and condition instead of absolute values seem to be the true path to prevent AKI. Diuretics cannot be recommended but may be considered for prevention of fluid overload. The next challenge will be to evaluate pharmacologic options using biomarker-based approaches to find further preventive options and to continue the search for actual treatment modalities to aid repair of renal tissue.