Optimizing peri-operative care to prevent acute kidney injury

Post-operative acute kidney injury (AKI) is a common complication of surgery. Rates vary according to type of surgery, ranging from 13% following gastrointestinal surgery and 10% after orthopaedic surgery to 26% following cardiac surgery [1–3].Understanding the aetiology of post-operative AKI is vital to peri-operative optimization. However, the pathogenesis is complex and usually multifactorial (Figure 1). Renal hypoperfusion plays an important role in post-operative AKI. This can occur as a result of a number of different factors including hypovolaemia, loss of autoregulation during anaesthesia, cardiogenic shock, sepsis and high-risk medicines such as non-steroid anti-inflammatory drugs (NSAIDs) and inhibitors of the renin–angiotensin system