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  • Image not available.Creatinine clearance measurements are the most accurate method available for clinically assessing overall renal function.
  • Image not available.The accumulation of morphine and meperidine metabolites has been reported to prolong respiratory depression in some patients with renal failure.
  • Image not available.Succinylcholine can be used safely in the presence of renal failure if the serum potassium concentration is less than 5 mEq/L at the time of induction.
  • Image not available.The extracellular fluid overload from sodium retention—together with the increased demand imposed by anemia and hypertension—makes patients with chronic renal failure particularly prone to congestive heart failure and pulmonary edema.
  • Image not available.Delayed gastric emptying secondary to autonomic neuropathy in some patients can predispose patients with chronic renal failure to aspiration perioperatively.
  • Image not available.Controlled ventilation should be considered for patients with renal failure. Inadequate spontaneous or assisted ventilation with progressive hypercarbia under anesthesia can result in respiratory acidosis that may exacerbate preexisting acidemia, lead to potentially severe circulatory depression, and dangerously increase serum potassium concentration.
  • Image not available.Procedures associated with a relatively high incidence of postoperative renal failure include cardiac and aortic reconstructive surgery.
  • Image not available.Intravascular volume depletion, sepsis, obstructive jaundice, crush injuries, recent contrast dye injections, and aminoglycoside, angiotensin-converting enzyme inhibitor, or nonsteroidal antiinflammatory drug therapy are additional major risk factors for an acute deterioration in renal function. Prophylaxis against renal failure with generous hydration together with solute diuresis appears to be effective and indicated in high-risk patients undergoing cardiac, major aortic reconstructive, and possibly other surgical procedures.
  • Image not available.The consequences of excessive fluid overload—namely, pulmonary congestion or edema—are easier to treat than those of acute renal failure.

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Diseases affecting the kidneys are often grouped into syndromes based on common clinical and laboratory findings: nephrotic syndrome, acute renal failure, chronic renal failure, nephritis, nephrolithiasis, and urinary tract obstruction and infection. The anesthetic care of patients with these syndromes is facilitated by grouping patients according to the status of their preoperative renal function rather than by syndrome. This chapter examines the basis for this approach and the anesthetic considerations applicable within each group. Renal physiology and the effects of anesthesia on renal function are discussed in Chapter 31.

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Accurate assessment of renal function relies heavily on laboratory determinations (Table 32–1). Renal impairment can be due to glomerular dysfunction, tubular dysfunction, or obstruction of the urinary tract. Because abnormalities of glomerular function cause the greatest derangements and are most readily detectable, the most useful laboratory tests are those related to the glomerular filtration rate (GFR; see Chapter 31).

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Table Graphic Jump Location
Table 32–1. Grouping of Patients According to Glomerular Function.
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Blood Urea Nitrogen

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The primary source of urea in the body is the liver. ...

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