Preop Care of
Renal Failure
Consider the cause of the patient's renal
failure.
- see ARF and CRF notes
Investigations
Renal opinion
Test urine for infection
Renal USS for shrinkage, duplex for artery stenosis.
Important
points
Manage hypertension
Stop nephrotoxic drugs, eg ACEi, NSAIDs.
Transfusion is rarely necessary
- and alters the flow characteristics of blood, acutely worsening renal
function.
Ensure adequate hydration:
- do not deny oral fluids >4-6hrs without IV replacement
For example
A pt is starved pre op
--> mild intravascular volume depletion
--> fewer nephrons, so each has to carry increased solute to excrete
required waste
--> osmotic diuresis ensues
--> dehydration and worsening renal failure.
Renal Transplant Pts
All renal transplant pts requiring surgery should be managed in
conjunction with their nephrologist
- skilled assistance is required for immunosuppression and to reduce
likelihood of acute rejection.