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    Perioperative acute renal failure.

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    Authors
    Mahon, Padraig
    Shorten, George
    Affiliation
    Department of Anaesthesia, Cork University Hospital, Wilton, Cork, Ireland., rsimahon@hotmail.com
    Issue Date
    2012-02-03T15:05:09Z
    MeSH
    *Acute Kidney Injury/drug therapy/etiology/prevention & control
    Animals
    Humans
    *Postoperative Complications/drug therapy/etiology/prevention & control
    Rats
    Risk Factors
    
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    Citation
    Curr Opin Anaesthesiol. 2006 Jun;19(3):332-8.
    Journal
    Current opinion in anaesthesiology
    URI
    http://hdl.handle.net/10147/208842
    DOI
    10.1097/01.aco.0000192819.76353.b3
    PubMed ID
    16735819
    Abstract
    PURPOSE OF REVIEW: Recent biochemical evidence increasingly implicates inflammatory mechanisms as precipitants of acute renal failure. In this review, we detail some of these pathways together with potential new therapeutic targets. RECENT FINDINGS: Neutrophil gelatinase-associated lipocalin appears to be a sensitive, specific and reliable biomarker of renal injury, which may be predictive of renal outcome in the perioperative setting. For estimation of glomerular filtration rate, cystatin C is superior to creatinine. No drug is definitively effective at preventing postoperative renal failure. Clinical trials of fenoldopam and atrial natriuretic peptide are, at best, equivocal. As with pharmacological preconditioning of the heart, volatile anaesthetic agents appear to offer a protective effect to the subsequently ischaemic kidney. SUMMARY: Although a greatly improved understanding of the pathophysiology of acute renal failure has offered even more therapeutic targets, the maintenance of intravascular euvolaemia and perfusion pressure is most effective at preventing new postoperative acute renal failure. In the future, strategies targeting renal regeneration after injury will use bone marrow-derived stem cells and growth factors such as insulin-like growth factor-1.
    Language
    eng
    ISSN
    0952-7907 (Print)
    0952-7907 (Linking)
    ae974a485f413a2113503eed53cd6c53
    10.1097/01.aco.0000192819.76353.b3
    Scopus Count
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    Cork University Hospital

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