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Perioperative care of the renal patient
P. S.
Kellerman
Division of
Nephrology, University of California-Davis Medical Center,
Sacramento.
Due to
the hormonal and hemodynamic alterations inherent in the
surgicalexperience, acute renal failure is common during
the perioperative period.Acute renal failure occurs in
5% of hospital admissions, and the surgicalsetting is
the second most common cause of inpatient acute renal failure.
Because this setting has the highest mortality for acute renal
failure,recognition of high-risk patients is essential
for careful monitoring andprophylactic measures.
Patients with chronic renal insufficiency, elderly
patients, jaundiced patients, diabetics, and those undergoing
cardiac oraortic surgery are at greatest risk for
perioperative acute renal failure.Patients with severe
chronic renal failure or end-stage renal disease areat
significant risk for development of complications during the
perioperative period, due both to renal and nonrenal reasons.
Hyperkalemia,infections, arrhythmias, and bleeding
commonly occur in these patientsduring the perioperative
period. This population has a reasonable surgical
mortality for both general and cardiac surgery, but the
extremely highmorbidity warrants careful perioperative
monitoring and care.
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