Term
|
Definition
To maintain a constant extracellular environment
Regulates the excretion of fluid and electrolytes |
|
|
Term
Number of patients enrolled in ESRD Medicare funded program
Number of patients enrolled in ESRD Medicare funded program |
|
Definition
In 1983: 86,354
In 2008: 547,982
approx. $39.86 Billion |
|
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Term
|
Definition
| Metabolized by the kidneys |
|
|
Term
|
Definition
Secreted by the juxtaglomerular apparatus
Acts on angiotensinogen angiotensin I |
|
|
Term
| Angiotensin I --> angiotensin II |
|
Definition
Potent renal artery vasoconstrictor ( DEC GFR & RBF)
Leads to release of aldosterone from the adrenal cortex |
|
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Term
|
Definition
produced in renal medulla
Vasodilator & enhances effects of ADH |
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Term
|
Definition
| hydrostatic pressure minus plasma oncotic pressure |
|
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Term
|
Definition
about 125 ml/min
About 90% is reabsorbed |
|
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Term
|
Definition
| dec hydrostatic pressure = dec GFR = dec urinary output |
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Term
|
Definition
|
|
Term
| RBF is autoregulated between |
|
Definition
60 to 160 torr
dec renal blood flow --> inc renin release --> dec RBF |
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Term
| Factors that decrease RBF |
|
Definition
Hypovolemia
Hemorrhage
Dehydration
Anesthesia (relative) |
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Term
| Inc Catecholamine release |
|
Definition
| Dec RBF even in the presence of adequate perfusion pressure |
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Term
|
Definition
|
|
Term
|
Definition
|
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Term
|
Definition
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Term
|
Definition
|
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Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Blood urea nitrogen (BUN) |
|
Definition
Varies inversely with GFR
A slow rate of fluid flow through tubules BUN
CHF (most common cause)
Dehydration
inc BUN in the presence of a normal GFR
High protein diet
GI bleed
inc catabolism with a febrile illness |
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|
Term
| Factors that produce a decrease in BUN |
|
Definition
|
|
Term
| A BUN > 50 mg/dl almost always reflects a decrease in |
|
Definition
|
|
Term
|
Definition
A specific indicator of GFR
Independent of protein metabolism
Independent of rate of flow through renal tubules |
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Term
| Plasma Creatinine in the Elderly |
|
Definition
May remain normal with GFR
Due to decrease in skeletal muscle mass
A modest increase in plasma creatinine should suggest significant renal disease in the elderly |
|
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Term
|
Definition
The most reliable clinical estimate of GFR
Moderate renal dysfunction is present when creatinine clearance values are < 25 ml/min
Renal Insufficiency at <25mL/min
Decrease doses of renal excreted drugs
Patients with a creatinine clearance of < 10 ml/min are considered anephric
Will require hemodialysis for water and electrolyte hemostasis |
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Term
|
Definition
| > 1.018 after an overnight fast makes renal tubular dysfunction unlikely |
|
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Term
|
Definition
| < 300 mOsm/L after standard periods of water deprivation makes renal tubular dysfunction likely |
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|
Term
High output renal failure
Also known as nephrogenic diabetes insipidus
Causes: |
|
Definition
Fluoride nephrotoxicity
Lithium
Amphotericin B
Osmotic diuretics
Hypercalcemia
Hypokalemia |
|
|
Term
|
Definition
Decreased ability to resorb sodium indicates renal failure
Suggested if urinary excretion of Na+ is > 40 mEq/L |
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Term
|
Definition
Severe proteinuria (> 3 g/day) reflects significant glomerular disease
Micro-albuminuria is the earliest sign of diabetic nephropathy |
|
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Term
|
Definition
RBC casts are diagnostic of glomerulonephritis or vasculitis
Epithelial cells w/acute renal failure is suggestive of acute tubular necrosis |
|
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Term
|
Definition
| May not reflect the severity of renal dysfunction |
|
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Term
|
Definition
| DO NOT interfere with normal autoregulation of GFR or RBF |
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|
Term
| Inhaled anesthetics depress |
|
Definition
| renal function by decreasing CO and BP |
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|
Term
| Regional anesthesia may depress |
|
Definition
| renal function by decreasing perfusion pressure |
|
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Term
|
Definition
Increases the circulating levels of ADH
Increases the circulating levels of renin |
|
|
Term
| Positive pressure ventilation |
|
Definition
Increased atrial pressures
Decreased release of atrial natriuretic factor |
|
|
Term
Factors that alter renal function:
Pre-anesthetic hydration:
Attenuates: |
|
Definition
Decreases in CO and BP
Decreases in perfusion pressure
Increases in plasma ADH levels
Increases in renin levels |
|
|
Term
Direct Nephrotoxicity
Defluorination toxicity |
|
Definition
Depends upon the duration of exposure to fluoride
Decreased GFR increases exposure time
The plasma levels of fluoride
50 µM/L of fluoride required to produce nephrotoxicity
May be substantially less with prolonged exposure |
|
|
Term
Defluorination toxicity:
Symptoms: |
|
Definition
Inability to concentrate urine (high output failure)
Polyuria --> dehydration, hypernatremia, and plasma osmolarity |
|
|
Term
Defluorination toxicity:
Causative agents: |
|
Definition
Halothane and Isoflurane:
Insufficient levels of plasma fluoride to produce nephrotoxicity
Methoxyflurane:
Produces 61 µM/L after 2.5 MAC hours
Enflurane:
May produce a decrease in urine concentrating ability with prolonged exposure
Should be avoided in patients with pre-existing renal disease
Sevoflurane:
Produces similar levels of fluoride as Enflurane and should be subject to the same considerations. |
|
|
Term
| Progressive and irreversible loss of functioning nephrons with an associated decrease in GFR |
|
Definition
Asymptomatic when at least 40% of nephrons continue to function
Develop renal insufficiency with 10% to 40% of nephrons functioning
Develop uremia with < 10% of functioning nephrons |
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|
Term
|
Definition
Increased CO
Right shift of the oxy-hemoglobin curve |
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|
Term
Chronic Renal Failure
Altered hydration and electrolyte balance |
|
Definition
Unpredictable intravascular volume
Hyperkalemia
Hypermagnesemia
Hypocalcemia |
|
|
Term
| Characteristics of Chronic RF |
|
Definition
Chronic anemia
Increased CO
Right shift of the oxy-hemoglobin curve
Pruritus
Coagulopathies
Platelet dysfunction
Systemic heparinization
Altered hydration and electrolyte balance
Unpredictable intravascular volume
Hyperkalemia
Hypermagnesemia
Hypocalcemia
Metabolic acidosis |
|
|
Term
| Characteristics of Chronic RF |
|
Definition
Systemic hypertension
CHF
Attenuated sympathetic nervous system activity due to therapy with antihypertensive drugs
inc susceptibility to infection
Decreased activity of phagocytes
Immunosuppressant drugs |
|
|
Term
Coagulopathies
A prolonged bleeding time in the presence of normal: |
|
Definition
prothrombin time
plasma thromboplastin time
platelet count |
|
|
Term
| Bleeding is most common from |
|
Definition
gastrointestinal tract (most common)
epistaxis
hemorrhagic pericarditis
subdural hematoma |
|
|
Term
|
Definition
Desmopressin (0.3-0.4 mg/kg IV over 30-mins)
Cryoprecipitate
Estrogen therapy
Erythropoietin (raise HCT to >26%) |
|
|
Term
|
Definition
Most serious electrolyte abnormality
ECG changes:
Peaked T waves
Prolongation of the P-R interval
Prolongation of the QRS complex
Complete heart block
Atrial / Ventricular fibrillation |
|
|
Term
|
Definition
Postpone surgery until the potassium is < 5.5 mE/L
Measure K+ immediately prior to surgery
Treatment:
Hyperventilation
Glucose with insulin
IV calcium |
|
|
Term
|
Definition
| Susceptible to pathologic fractures during positioning for anesthesia and surgery |
|
|
Term
|
Definition
Magnesium may be inc with chronic RF
Especially if magnesium-containing antacids are used
CNS depression due to magnesium
Coma
Hypotension
Hypoventilation
Potentiation of all muscle relaxants |
|
|
Term
|
Definition
The kidneys normally excrete 50 to 100 mEq of hydrogen ions per day
Chronic metabolic acidosis is likely (pH <7.3)
Treat severe metabolic acidosis with bicarbonate before surgery
Correct it slowly
Dose (mEq) = 0.3 x (Kg) x SBE (mEq)
Give ½ of the result
Rapid correction may precipitate seizures |
|
|
Term
|
Definition
Affects > 80% of patients with ESRD
Most significant risk factor for:
CHF \ MI
CVA
Causes:
Intravascular volume expansion
Activation of the renin-angiotensin-aldosterone system
Control:
Antihypertensive drugs (ACE-I or Calcium Blockers)
Hemodialysis often ineffective |
|
|
Term
|
Definition
Pericardial effusion with or without cardiac tamponade
Acute pericardial tamponade is the principle life-threatening complication of uremic pericarditis
Treatment:
Hemodialysis and / or pericardiocentesis |
|
|
Term
| Nervous System Abnormalities |
|
Definition
Abnormalities of the CNS and peripheral nervous system are likely
Encephalopathy may be present
Seizures may occur
A distal symmetric mixed motor and sensory polyneuropathy may develop
Most common: median and common peroneal nerve
Autonomic nervous system dysfunction is possible
May attenuate the compensatory responses to changes in blood volume and positive-pressure ventilation |
|
|
Term
Nervous System Abnormalities
Treatment |
|
Definition
Hemodialysis may reverse:
uremic encephalopathy
uremic neuropathy |
|
|
Term
|
Definition
The most serious problem facing patients with chronic renal failure
Sepsis is the most common cause of death
Frequently pulmonary in origin
Strict asepsis when placing
Vascular catheters
Endotracheal tubes
Increased incidence of viral hepatitis/AIDS
Frequent use of blood products |
|
|
Term
|
Definition
The most important observation in these patients is an assessment of whether the disease is stable, progressing, or improving
Monitor plasma concentration of creatinine |
|
|
Term
Anesthetic Management
Preoperative Evaluation |
|
Definition
Consider the physiologic changes associated with renal failure
Consider concomitant drug therapy
Continue antihypertensive drugs
Evaluate insulin therapy for the diabetic patient
Observe for digitalis toxicity
Consider the amount of renal clearance of these drugs |
|
|
Term
Anesthetic Management
Preoperative Evaluation |
|
Definition
Estimate blood volume
Weigh the patient before and after dialysis
Considerations for vital signs
Orthostatic hypotension
Heart rate
Measure atrial filling pressures |
|
|
Term
Anesthetic Management
Preoperative Evaluation |
|
Definition
Preoperative medication concerns:
Must be individualized
Uremia delays gastric emptying
Unexpected sensitivity to CNS depressant drugs |
|
|
Term
Anesthetic Management
Induction of Anesthesia |
|
Definition
Use routine induction agents
Give slowly - possible hypotension
Muscle relaxants
Rapid-sequence induction due to delayed gastric emptying
Consider succinylcholine
Consider the renal clearance and duration of action of the muscle relaxants |
|
|
Term
Anesthetic Management
Induction of Anesthesia:
Hypotension Concerns: |
|
Definition
Frequently respond as of they are hypovolemic
SNS may be attenuated by antihypertensive drugs
Impaired compensatory peripheral vasoconstriction
Hypotension is likely with:
small decreases in blood volume
positive-pressure ventilation
abrupt changes in position
drug-induced myocardial depression |
|
|
Term
Anesthetic Management
Induction of Anesthesia:
Hypotension Concerns: (cont.) |
|
Definition
Consider uremic disruption of the blood-brain barrier
Decreased protein binding of drugs may result in the availability of more unbound drug to act at receptor sites
Decrease Doses |
|
|
Term
Anesthesia Maintenance:
Patients not dependent on renal dialysis: |
|
Definition
Volatile anesthetic
Nitrous oxide
Short acting opioid |
|
|
Term
Patients not dependent on renal dialysis:
Volatile anesthetic agents |
|
Definition
advantages
helps in controlling intraoperative hypertension
reduces the dosage of muscle relaxants necessary for surgery
disadvantages
excessive depression of cardiac output
Reduction in tissue blood flow must be minimized in anemic patients |
|
|
Term
Patients not dependent on renal dialysis:
Volatile anesthetic agents
Agent of choice: |
|
Definition
Isoflurane or Desflurane are probably the best choices
Halothane may be contraindicated due to the high incidence of existing liver disease
Sevoflurane and Enflurane should be avoided because of the potential for fluoride toxicity |
|
|
Term
Patients not dependent on renal dialysis:
Volatile anesthetic agents |
|
Definition
Nitrous oxide
Advantages
decrease the concentration of volatile anesthetic agent
less myocardial depression
Disadvantages
decreased concentration of delivered oxygen
Typically patients are anemic |
|
|
Term
Patients not dependent on renal dialysis:
Opioids: |
|
Definition
Advantages:
decrease the concentration of volatile anesthetic agent
less myocardial depression
avoid concerns of liver and kidney toxicity
Disadvantages:
not reliably effective in controlling intraoperative hypertension
possible prolonged sedation and depressed ventilation |
|
|
Term
Patients not dependent on renal dialysis:
Control of hypertension: |
|
Definition
Administer a vasodilator
hydralazine
nitroprusside
beta-blockers ??? |
|
|
Term
Patients not dependent on renal dialysis:
Ventilation concerns: |
|
Definition
Maintain normocapnia
Minimize the effects of positive pressure intra-thoracic pressure on cardiac output
Hypoventilation produces acidosis
Hyperventilation produces alkalosis |
|
|
Term
| Patients dependent on renal dialysis |
|
Definition
Nitrous oxide
Volatile agent
Isoflurane
Enflurane
Sevoflurane
Desflurane
Consider liver disease
avoid halothane |
|
|
Term
|
Definition
Brachial plexus block for placement of a vascular shunt
Excellent anesthesia / high volume anesthetic
Duration probably not shortened |
|
|
Term
| General concerns for regional anesthesia |
|
Definition
The presence of coagulopathies
The presence of neuropathies
Metabolic acidosis may decrease the seizure threshold
Therefore higher risk with high volume anesthetic blocks |
|
|
Term
|
Definition
Renal disease slows the clearance of long-acting non-depolarizing muscle relaxants from the plasma
Doses need to be decreased
Atracurium and Mivacron do not have prolonged duration of action |
|
|
Term
Muscle relaxants:
Renal excretion of anticholinesterase drugs |
|
Definition
neostigmine - 50%
edrophonium - 75%
pridostigmine - 75%
Prolonged action of anticholinesterase drugs make recurization unlikely |
|
|
Term
Muscle relaxants
Causes of recurizartion |
|
Definition
Inadequate initial neuromuscular reversal
Respiratory acidosis
Electrolyte derangements
Drug-induced effects (antibiotics) |
|
|
Term
Fluid management and urine output
For patients not requiring hemodialysis |
|
Definition
Pre-hydrate with 10 to 20 ml/kg of a balanced salt solution in the preoperative period
Lactated ringers solution (4mEq/L of K+) or other potassium containing solutions should be avoided in the anuric patient
Usually Normal Saline or D5W |
|
|
Term
Fluid management and urine output
For patients not requiring hemodialysis
Goal: |
|
Definition
Maintain urine output > 0.5 ml/kg/hr
Give 3 to 5 ml/kg/hr BSS
IF GFR is decreased due to ADH secretion
Furosemide 5mg IV is often effective
For dec RBF in the presence of hypovolemia give a 500 ml bolus of BSS
Avoid diuretics in the hypovolemic patient |
|
|
Term
Fluid management and urine output
For patients not requiring hemodialysis
If fluid not effective in restoring urine output:
Consider |
|
Definition
CHF
Give dopamine (0.5 to 3 mcg/kg/min) to:
Increase RBF
Dopamine (3 to 10 mcg/kg/min) to:
Treat CHF induced oliguria,
Consider mechanical blockage of the catheter
Consider the patient’s position on catheter drainage |
|
|
Term
Fluid management and urine output
For patients requiring hemodialysis |
|
Definition
| Absence of renal function narrows the margin of safety between insufficient and excessive fluid administration |
|
|
Term
Fluid management and urine output
For patients requiring hemodialysis
Non-invasive operations |
|
Definition
Replace insensible water loss
5% glucose in water (5 to 10 ml/kg)
Small amount of urine output
Replace with 0.45% NaCl |
|
|
Term
Fluid management and urine output
For patients requiring hemodialysis
Thoracic or abdominal surgery |
|
Definition
Possibly significant intravascular fluid loss
Replace with:
a balanced salt solution
5% albumin solution (Plasmanate)
Blood to oxygen-carrying capacity or to replace excessive blood loss |
|
|
Term
Monitoring:
Minor procedures: |
|
Definition
Routine, non-invasive monitors
Major operative procedures:
Arterial line
CVP
Pulmonary artery catheter
Stroke Volume Variation (Vigileo-Flo TracTM) |
|
|
Term
Postoperative management:
Watch for: |
|
Definition
Recurization
Hypertension
Excessive sedation after opioid administration |
|
|
Term
| Treat perioperative oliguria promptly |
|
Definition
Urine output < 0.5 ml/kg/hr
Can lead to acute renal failure
Up to 50% mortality |
|
|
Term
| Perioperative renal failure account for 50% of cases requiring acute hemodialysis |
|
Definition
| The most common cause of acute renal failure is prolonged (30 to 60 min) renal hypoperfusion |
|
|
Term
Perioperative Oliguria
Treatment: |
|
Definition
Aggressive and early treatment is required
500 ml of BSS
Avoid the administration of a diuretic
If initial fluid challenge is not effective
Continue to give fluids if patient is not at risk for developing cardiac dysfunction
Continue to give fluids if the patient is at risk for developing cardiac dysfunction if filling pressures are normal or below normal |
|
|
Term
Perioperative Oliguria
Treatment |
|
Definition
In the presence of left atrial filling pressure
Consider CHF
Give dopamine 3 to 10 µg/kg/min
If dopamine ineffective - give:
Mannitol (0.5 to 1 g/kg IV) with or without Lasix (1 to 3 mg/kg/IV)
Hemodialysis for:
BUN > 100 mg/dl
Severe fluid overload, metabolic acidosis, hyperkalemia |
|
|
Term
| Causes of Perioperative Oliguria |
|
Definition
Prerenal (dec RBF):
Hypovolemia
dec cardiac output
Renal (Acute tubular necrosis)
Renal ischemia due to prerenal causes
Nephrotoxic drugs
Release of hemoglobin or myoglobin
Postrenal
Bilateral ureteral obstruction
Extravasation due to bladder rupture |
|
|
Term
| Primary Diseases of the Kidney |
|
Definition
Glomerulonephritis
Polycystic Renal Disease
Fanconi Syndrome
Bartter Syndrome
Renal Hypertension
Uric Acid Nephropathy
Hepatorenal Syndrome |
|
|
Term
Kidney Disease
Nephrolithiasis
Renal Stones |
|
Definition
Treatment
Basket extraction, Laser Removal, Removal via surgical incision
Extracorporeal shock-wave lithotripsy (ESWL)
Anesthesia Management:
General anesthesia, regional
Local infiltration / IV sedation (rare)
Goal: keep patient immobile
Keep HR Stable |
|
|
Term
Benign Prostatic Hypertrophy
Incidence:
15 million American males
Symptoms: |
|
Definition
Initial
frequency
nocturia
a feeling of incomplete emptying
Progressive
Obstruction to urine flow
urinary retention
renal failur |
|
|
Term
|
Definition
Transurethral resection of the prostate (TURP)
Most common surgical procedure >50yrs of age
Scraping of prostate until prostate is removed
Continuous irrigation of Glycine
Complications:
TURP Syndrome |
|
|
Term
TURP SYNDROME
A syndrome of |
|
Definition
Dilutional hyponatremia
Volume overload
Cause:
Absorption of nonelectrolyte irrigating fluids during prostatic resection |
|
|
Term
|
Definition
Hypertension
Increased CVP
Bradycardia
Myocardial ischemia
Shock |
|
|
Term
TURP Syndrome
Central Nervous System |
|
Definition
Restlessness
Confusion
Nausea
Visual disturbances
Seizures
Coma |
|
|
Term
|
Definition
|
|
Term
|
Definition
Symptoms are more likely to develop if the serum sodium concentration is abruptly decreased below 120 mEq/L
Glycine:
Has an osmolarity of 288 mOsm/L
Produces profound hyponatremia
Produces transient visual disturbances
Functions as an inhibitory neurotransmitter in the retina
Metabolized to ammonia
Associated with postoperative somnolence |
|
|
Term
TURP Syndrome
Factors that influence absorption |
|
Definition
Hydrostatic pressure produced by irrigation fluid
Number and size of open venous sinuses
Peripheral venous pressure
Duration of surgery |
|
|
Term
|
Definition
The duration of resection should not exceed 60 minutes
The hydrostatic pressure should not exceed 70 cm H20
Approximately 10 to 30 ml of irrigation fluid is absorbed for every 1 minute of resection time
Volumes exceeding 1200mL have been absorbed in 75-120mins of surgery |
|
|
Term
TURP Syndrome
Management of Anesthesia |
|
Definition
Spinal anesthesia:
Anesthetic of choice
At least a T-10 level is required
General anesthesia:
May mask CNS signs of excessive intravascular fluid absorption
Required in uncooperative patients |
|
|
Term
TURP Syndrome
Management of Anesthesia:
Monitors:
Observe for signs of fluid absorption - monitor: |
|
Definition
plasma sodium concentration
osmolarity
hematocrit
CVP ()
blood pressure ()
Blood loss:
15 ml/g of resected tissue |
|
|
Term
|
Definition
Mannitol
Lasix
Hypertonic saline |
|
|
Term
Renal Transplantation
Treatment of ESRD
Most common causes of ESRD |
|
Definition
Diabetes mellitus
glomerulonephritis
polycystic kidney disease
hypertension |
|
|
Term
| Kidneys from cadaver donors can be preserved at low temperatures |
|
Definition
|
|
Term
| Attempts are made to match |
|
Definition
between donor and recipient:
ABO blood groups
Human leukocyte antigens
The donor kidney is placed in the lower abdomen
Receives blood supply from iliac vessels |
|
|
Term
Renal Transplantation
The ureter is anastomosed directly |
|
Definition
to the bladder
Diseased Kidney is not removed
Immunosuppressive therapy is instituted during the perioperative period |
|
|
Term
Renal Transplantation
Management of Anesthesia |
|
Definition
Same principles as that for chronic renal failure
Hemodialysis before surgery
Optimize coagulation and hydration
Improve electrolyte and acid-base status
May also cause dehydration
Monitor blood glucose levels in the diabetic
Strict asepsis |
|
|
Term
Renal Transplant
Management of Anesthesia:
Regional anesthesia:
Advantages: |
|
Definition
Elimination of the need for intubation of the trachea in an immunosuppressed patient
Elimination of the need to administer muscle relaxants |
|
|
Term
Renal transplant
Regional Anesthesia
Disadvantages: |
|
Definition
Frequently requires heavy sedation
Complicate blood pressure control
Unpredictable intravascular fluid volume status
Controversial in the presence of coagulation abnormalities
Recommendation:
Use General Anesthesia |
|
|
Term
Renal Transplantation
Management of Anesthesia:
General anesthesia |
|
Definition
Nitrous oxide, volatile anesthetic, short-acting opioid
Isoflurane and Desflurane agents of choice
Avoid Enflurane and Sevoflurane
Fluoride ion metabolite and decreased GFR
Avoid halothane
Frequent hepatic dysfunction
Minimize cardiac depression
Maintain tissue oxygenation |
|
|
Term
Renal Transplantation
Management of Anesthesia:
General anesthesia:
Muscle relaxants |
|
Definition
Consider the route of elimination
Consider atracurium or mivacron
Fluid management (CVP monitor)
IV replacement of intravascular fluid lost during surgery
IV fluids to optimize intravascular fluid volume
Avoid potassium containing solutions
Give blood to improve oxygen delivery |
|
|
Term
Renal Transplantation
Management of Anesthesia:
Diuretics |
|
Definition
An osmotic diuretic such as Mannitol will facilitate urine formation and output and reduce excess tissue and intravascular volume
Loop diuretics require renal tubular concentrating mechanisms to produce diuresis
Lasix
Ethacrynic acid
Both will not work until clamp is removed |
|
|
Term
Renal Transplantation
Management of Anesthesia:
Other concerns: |
|
Definition
Release of the occlusion clamp will allow blood to flow to the newly anastomosed kidney
May cause hypotension
May produce excessive hyperkalemia
Wash out of the potassium containing solution used to preserve the kidney
Cardiac arrest has been reported |
|
|
Term
Renal Transplant
Complications: |
|
Definition
Acute immunologic rejection of the newly transplanted kidney
May cause DIC
Only treatment: remove the kidney
Postoperative hematoma in the graft may vascular or ureteral obstruction
Delayed graft rejection |
|
|
Term
| Patients at Risk for Perioperative Renal Failure |
|
Definition
Co-existing renal disease
Hypovolemia
Cirrhosis of the liver
Biliary tract obstruction
Sepsis
Advanced age
Multiple organ system trauma
CHF
AAA resection
Cardiopulmonary bypass |
|
|
