Perioperative Renal Dysfunction In Cardiac Surgery

CPB surgery is associated with a high risk for AKI. This injury is associated further with substantial morbidity and mortality. The pathogenesis of kidney injury during CPB is complex and involves hemodynamic, inflammatory, and other mechanisms that interact at a cellular level.At present, no pharmacologic interventions have demonstrated conclusively efficacy in the prevention of renal dysfunction after cardiac surgery. Therapies such as recombinant human ANP, fenoldopam and N-AC have shown modestly encouraging results in small trials and need to be confirmed in larger studies that are designed appropriately to assess renal outcomes.The role of biomarkers is to predict the risk of AKI and to improve individualised patient care focuses on the identification of early predictive biomarkers such as urine neutrophils gelatinase-associated lipocalin (NGAL), urinary IL-8, and liver fatty acid-binding protein.RRT is frequently used to support these patients with AKI. Although the adequacy of RRT dosing has been determined in recent good quality trials, there still exist areas of uncertainties about RRT.