Postoperative Renal Function Monitoring
Close postoperative monitoring of renal function is essential, particularly in the first 48–72 hours after surgery. Serum creatinine, urine output, and electrolyte levels should be monitored frequently to detect any worsening of AKI. Postoperative fluid management should be carefully adjusted based on the patient’s renal function and volume status.
Renal Replacement Therapy (RRT)
For patients with severe acute kidney injury, renal replacement therapy (RRT) may be necessary, either preoperatively or postoperatively. Indications for RRT include refractory hyperkalemia, severe acidosis, uremia, or fluid overload that is not responsive to diuretics. The timing and modality of RRT (intermittent hemodialysis vs. continuous renal replacement therapy) should be individualized based on the patient’s clinical condition.
Pain Management
Pain management in acute kidney injury patients should avoid nonsteroidal anti-inflammatory drugs (NSAIDs) due to their nephrotoxic potential. Opioids can be used but must be dosed carefully, considering any potential accumulation in renal dysfunction. Regional anesthesia may be beneficial in reducing systemic opioid requirements, but careful consideration must be given to the patient’s coagulation status and overall condition.
