TY - CHAP M1 - Book, Section TI - Chapter 14. Evaluation of the Patient with Renal Disease A1 - Stafford-Smith, Mark A1 - Raja, Atif A1 - Shaw, Andrew D. A2 - Longnecker, David E. A2 - Brown, David L. A2 - Newman, Mark F. A2 - Zapol, Warren M. PY - 2012 T2 - Anesthesiology, 2e AB - 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.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.Although the search continues for a substance with "ideal" properties to assess glomerular filtration (ie, steady production, complete filtration, no secretion or absorption, convenient inexpensive measurement) through its clearance from the circulation, serum creatinine and creatinine clearance are the current clinical standard.Kidney-mediated acid–base, electrolyte, and/or fluid disorders are common preoperatively and may be sufficiently important to require correction before surgery can proceed.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.Prevention is the most important tool in the approach to perioperative acute kidney injury; this requires knowledge of potential insults, including the renoprotective value of meticulous attention to minimizing hemodilution and transfusion.Major acute kidney injuries significantly impair the kidneys' ability to maintain the internal environment; in these situations adherence to guidelines aimed at preserving volume, electrolyte, acid–base, and nutrition balance within the limits of the remaining renal homeostatic reserve may be sufficiently effective that dialysis can be avoided.Patients with impaired renal filtration have altered responses to normal medication dosing; a simple prescribing approach for water-soluble agents involves a calculated percentage reduction in drug dosage to match the reduction in glomerular filtration. However, drug-level measurement or algorithms for a specific drug dosing may be recommended. SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/11/02 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=56624243 ER -