TY  - CHAP
M1  - Book, Section
TI  - The Patient With Renal Disease
A1  - Stafford-Smith, Mark
A2  - Longnecker, David E.
A2  - Mackey, Sean C.
A2  - Newman, Mark F.
A2  - Sandberg, Warren S.
A2  - Zapol, Warren M.
Y1  - 2017
N1  - 
T2  - Anesthesiology, 3e
AB  - KEY  POINTSKidney  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,  for  whom  differentiating  normal  from  abnormal  may  be  challenging  and  even  counterintuitive.Serum  creatinine  and  creatinine  clearance  remain  the  current  clinical  standard  to  assess  steady-state  glomerular  filtration,  although  the  search  continues  for  substances  with  more  “ideal”  properties  (ie,  steady  production,  complete  filtration,  no  secretion  or  absorption,  convenient  inexpensive  measurement)  and  other  “early  biomarkers”  that  more  rapidly  identify  sudden  changes  in  kidney  function.Kidney-mediated  acid–base,  electrolyte,  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  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1144112975
ER  -