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.