Perioperative management of patients with chronic renal failure and postoperative acute renal failure

In the patient with severe renal failure who is not yet on dialysis, the most important principle is to obtain and maintain homeostasis and avoid further acute deterioration of renal function. The first part of this article will be devoted to these patients. In the patient on chronic hemodialysis who needs an operation, special considerations include the timing of the operation with dialysis and the avoidance of damage to the blood access site. A brief section will address these particular problems. The most common cause of acute renal failure has always been acute tubular necrosis. Since the mid-1940's, the most common cause of acute tubular necrosis has been surgery. Approximately 30 patients per million population will, every year, require dialysis for acute renal failure. Twenty of these patients will have acute tubular necrosis, 15 as the result of surgical complications. The last part of this article will be devoted to this problem.