Longnecker's Anesthesiology > Part 2. Preparing for Anesthesia > Section B. Preoperative Evaluation of the Anesthesia Patient > Chapter 13. Evaluation of the Patient with Renal Disease Mark Stafford-Smith, MD, CM, FRCPC, George Lappas, MD, and Andrew D Shaw, MB, BS, FRCA

Key Points

"1. Kidney functions are centrally involved in whole-body homeostasis and normally keep body fluid volume, osmolarity, electrolyte content and concentration, and acidity within narrow limits.

2. Knowledge of normal kidney function is particularly important to interpret the physiology of the neonate, the parturient, and the elderly patient, where differentiating normal from abnormal may be challenging and even counterintuitive.

3. While the search for a substance with "ideal" properties (i.e., steady production, complete filtration, no secretion or absorption, convenient inexpensive measurement) to assess glomerular filtration rate through its clearance from the circulation continues, serum creatinine and creatinine clearance are the current clinical standards.

4. Kidney-mediated acid–base, electrolyte, and/or fluid disorders are common preoperatively and may be sufficiently important to require correction before surgery can proceed.

5. Familiarity with the spectrum of acute and chronic renal disorders that may be encountered in the perioperative patient is essential to logically anticipate perioperative problems and design rational therapeutic strategies.

6. Prevention is the most important tool in the approach to perioperative acute renal injury; this requires knowledge of potential insults, including the renoprotective value of meticulous..."