PERIOPERATIVE ANAESTHETIC MANAGEMENT IN RENAL SURGERIES: CLINICAL OUTCOMES AND PHARMACOLOGICAL CONSIDERATIONS

Abstract

Renal surgery and nephron sparing surgery, complicated urologic surgery, and kidney transplantation are being done in patients who already have chronic kidney disease, end-stage renal disease and multiple comorbidities, placing them at a high risk of perioperative acute renal injury (AKI) and progressive worsening of renal function over time. Kidney injury during the perioperative period is no longer considered a temporary complication, but an urgent predictor of the postoperative morbidity, graft functioning, and survival. Renal perfusion and minimization of nephrotoxic insults through optimization of perioperative care have thus taken centre stage in recent nephrology and renal surgery. This narrative review is a synthesis of the existing data about the perioperative management strategies that directly affect the renal outcomes in patients undergoing renal surgery and kidney transplantation, and specifically addresses the nephroprotective principles associated with the kidney specialists and surgical teams. The major pathways of perioperative renal injury, such as ischemia-reperfusion injury, hemodynamic instability, fluid shifts, and inflammatory activation, are discussed in various renal surgical settings. Perioperative fluid strategies, blood pressure and perfusion goals, electrolyte and acid-base control, and nephrotoxic exposures are also given special attention and directly affect renal perfusion, glomerular filtration, and graft performance. Kidney transplantation Perioperative management is addressed in reference to delayed graft functions, ischemia-reperfusion injuries, and interactions with immunosuppressive treatments. The new ideas of biomarker-based nephroprotection, improved recovery mechanisms during renal surgery, and perioperative care guided by precision are also mentioned. The results endorse the multidisciplinary approach between nephrologists, surgeons, anaesthesiologists, and critical care groups to enhance short and long-term kidney outcomes in patients who undergo renal surgical operations and kidney transplantation.