Insuffisance rénale aiguë postopératoire

The perioperative period is a renal risk situation. The hemodynamic and hormonal changes related to anaesthesia, the surgical stress associated with mechanical ventilation lead to dysregulation of the renal system, evolving towards a functional renal failure. When others factors, such as sepsis, hypovolemia or administration of nephrotoxic drugs are added, real kidney damage can occur, responsible of postoperative acute renal failure. The incidence of an acute renal failure in a perioperative context is rare but subject to a significant morbidity and mortality. The main risk factors for postoperative acute renal failure are either related to the patient (chronic renal failure, age, diabetes, hypertension...), or to the surgery (intraperitoneal surgery, emergency surgery). No pharmacological prophylaxis showed evidence of its effectiveness during the perioperative period. Prevention of postoperative acute renal failure is mainly based on the recognition of risk situations, the rational use of nephrotoxic drugs and the maintenance of blood volume and an adequate perfusion pressure. Important recent advances have been made for improving the early diagnosis of the acute renal failure with the study of specific biomarkers of the kidney, such as the neutrophil gelatinase-associated lipocalin (NGAL).