post op and renal failure

roma4204, BSN, RN · Jun 11, 2011

it depends. many abx can lead to renal failure, which are common post op. some bp meds can contribute. usually its a formula of multiple factors that come together perfectly to produce acute renal failure. chronic renal failure is another story of course.

i hope this isn't homework!

isthatso? · Jun 11, 2011

Thank you :). And no, it is not homework. It was a real life scenario that I came across. I was thinking to myself "what could've possible gone wrong?"

Biffbradford · Jun 11, 2011

After heart surgery there can be micro-emboli released (from calcified arteries), or there may have been an episode of hypotension.

CRNA1982 · Jun 11, 2011

Hello, I am a new nurse. Here's my question: what role does surgery have in bringing about renal failure? Say a pt had a surgery and he/she was receiving adequate fluids and nutrition. The labs are also being closely monitored. How does renal failure develop in such cases?

Renal failure s/p surgery is usually due to long periods of hypotension and inadequate fluid resuscitation peri-operatively. This leads to decreased renal perfusion and subsequently decreased urine output leading to ARF. If a pt. is being managed appropriately (as you noted) by replacing all NPO deficits, following labs, and staying on top of fluid requirements as well as maintaing BP within 20% of baseline; renal failure should not be an issue.

LiverpoolJane · Jun 12, 2011

The biggest causes of acute kidney injury (AKI) in the surgical setting are hypovolaemia and sepsis. Some surgical procedures are higher risk - there is about a 20 - 30% incidence of AKI following cardio-pulmonary by-pass surgery. Patients with and underlying chronic kidney disease (CKD) are more prone to also develop an AKI. Management is fluid and elctrolyte balance and acid-base balance as you often find they have a metabolic acidosis too. Some drugs are causes of decreased kidney function - some antibiotics, NSAIDs and contrast following radiological procedures are the main culprits.

Also another reason is urine retention - so bladder examination / USS to eliminate this.

ObtundedRN, BSN, RN · Jun 12, 2011

Anything that causes decreased perfusion to the kidneys during surgery can cause it. As many have stated, hypotension could be one cause. Or with cardiac/vascular surgery where they need to cross clamp the aorta above the renal arteries. They try to keep the clamp time down to a minimum, ARF is a huge quality indicator for our cardiothoracic surgeons. I believe it is a negative result for them if the patient's serum creatinine raises just 0.1 above their baseline.

GHGoonette, BSN, RN · Jun 12, 2011

Don't forget incompatible blood transfusion. Also, certain muscle relaxants used in neuro-muscular blockade may exacerbate an underlying renal condition, and can cause quite a dramatic drop in BP.

CABG patch kid, BSN, RN · Jun 12, 2011

As previously mentioned I think that hypotension either during or after the surgery will be one of the most common causes, though I'm wondering if this case you're referring to the person already had chronic renal insufficiency (baseline elevated creatinine?). If so then these people are more fragile when it comes to renal function and more likely to have acute on chronic renal failure. Also, in abdominal surgeries, patients are known to third space their fluid, so despite adequate fluid replacement they may not be holding enough in the vasculature. I even see this in AAA repairs (not a true gut surgery but they are in the abdominal cavity, as well as these patients have labile BP post op).