Preop Care of
Consider the cause of the patient's renal
- see ARF and CRF notes
Test urine for infection
Renal USS for shrinkage, duplex for artery stenosis.
Stop nephrotoxic drugs, eg ACEi, NSAIDs.
Transfusion is rarely necessary
- and alters the flow characteristics of blood, acutely worsening renal
Ensure adequate hydration:
- do not deny oral fluids >4-6hrs without IV replacement
A pt is starved pre op
--> mild intravascular volume depletion
--> fewer nephrons, so each has to carry increased solute to excrete
--> 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.