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oliguric
non oliguric
Poly uric renal failure
Burns Ischemia
Nephrotoxic drugs
Low output syndrome
(antibiotics)
Solvents (carbon
Renal artery stenosis tetrachloride, ethylene
glycol)
Relative decrease Radiographic contrast dyes
Sepsis Myoglobinuria
Hepatic failure
Allergic reaction
Pre Renal Azotemia
Most common type
Ischemia
ischemia
Post operative AKI
Antibiotids
Chemotherapeutic
toxic ingestions
Endogenous toxins
Contrast agents
(1) hypoxia in the renal outer medulla due to
perturbations in renal microcirculation and
occlusion of small vessels;
(2) cytotoxic damage to the tubules directly or via
the generation of oxygen free radicals, especially
since the concentration of the agent within the
tubule is markedly increased; and
(3) transient tubule obstruction with precipitated
contrast material
contrast
Prevention of radiocontrast nephropathy
depends on adequate hydration (e.g., 1 mL/kg
normal saline initiated at least 4 hours before
and continued for 12 hours after radiocontrast
administration)
Elective surgical procedures should be
deferred until the effects of the dye have been
evaluated and treated.
Nonionic, low-, or iso-osmolar radiocontrast
media are less nephrotoxic but are expensive
and offer optimal cost-benefit ratio when used
in high-risk situations only
Prevention of CONTRAST
N acetyl cystein
fendolopam
Antibiotics & chemotherapy
Aminoglycosides andamphotericin B both cause
tubular necrosis
Mb encephalopathy
Pericarditis
Coiagulopathy
Anaesthetic
Considerations
Anaesthetic Problems & Concerns
Fluid homeostasis -Hypotension, hypovolemia, CHF, HTN,
pulmonary edema, hypoalbuminemia
Electrolyte disturbances - Hyperkalemia, hypocalcemia
Acid-base disturbances - Metabolic acidosis, hypoxemia
Delayed gastric emptying - Aspiration
Arrhythmias, conduction blocks
Neurological complications
Dilutional Anemia
Infections
Effect on drug handling
Opioids
Morphine Conj. to M-3-G, M-6-G Active metabolite has renal Dose adjustment
, active metabolite, resp elimination, 40% conj required
depresion occurs in kidney
Meperidine Normeperidine, CNS Active metabolite has renal Dose adjustment
(Pethidine) toxicity elimination required
Fentanyl Plasma protein Clearance not altered safe
binding, free drug
Sufentanil Plasma protein Clearance not altered safe
binding, free drug
Alfentanil Initial vol of Clearance not altered safe
distribution, free drug
Remifentanil No change Clearance not altered safe
Inhalation Agents
Halothane Inorganic fluoride levels are less No Neprotoxicity
Isoflurane Inorganic fluoride levels are less No Neprotoxicity
Desflurane Inorganic fluoride levels are very less, highly No Neprotoxicity
stable & resists degradation by soda-lime & liver
Sevoflurane Inorganic fluoride levels are less but not stable , Compound A is
degraded by soda-lime to compound A & neprotoxic
undergoes liver metabolism