Perioperative Acute Renal Failure: Diagnosis and Management

Acute renal failure (ARF) is an important and often preventable complication of hospitalization. Patients with even modest increases in their serum creatinine have increases in their mortality, length of stay, and hospital costs. Postoperative ARF represents 9% to 25% of all cases of hospital-acquired renal insufficiency. Risk factors for postoperative ARF can be identified in advance and preventive measures taken to avoid the development of renal insufficiency. The following module explains the roles of medical treatment in lowering the risk of perioperative ARF, the typical presentation of ARF postoperatively, the diagnostic approach to perioperative ARF, and the initial treatment once ARF develops.

To provide hospitalists with current management strategies regarding the prevention, identification, and treatment of patients with perioperative acute renal failure.

This activity is designed for hospitalists. No prerequisites required.

After completing the module, the participant should be able to:

1. Describe the definitions, epidemiology, and risk factors for the development of perioperative acute renal failure (ARF).
2. Explain the workup and tests that will help establish the etiology of hospital-acquired ARF.
3. Analyze the evidence for medical ARF risk reduction therapies.
4. Identify medications commonly implicated in causing ARF among inpatients and how to prevent ARF from these medications.
5. Describe preventive measures than can be taken to avoid contrast-induced nephropathy.
6. Explain the presenting features and management of acute interstitial nephritis in the hospitalized patient.

The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

Accreditation Statement: The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement: The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 AMA PRA Category 1 Credit(s)^™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date: September 30, 2008. Expiration date: September 30, 2012.

Estimated time to complete activity: 2 hours

Full Disclosure Policy Affecting CME Activities: As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of The Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following:

^*Instructor, Harvard Medical School, Associate Physician, Brigham and Women’s Hospital, Boston, Massachusetts.

^†Associate Professor, Harvard Medical School, Medical Director, Brigham and Women’s/Faulkner Hospitalist Service, Boston, Massachusetts.

Conflict of Interest: Dr Schaffer reports having no significant financial or advisory relationships with corporate organizations related to this activity; Dr McKean reports receiving honoraria from Sanofi-Aventis.

Off-Label Product Discussion: All faculty have indicated that they have not referenced unlabeled or unapproved uses of drugs or devices.

Disclaimer: The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.

Address correspondence to: Adam Schaffer, MD, Instructor, Harvard Medical School, Associate Physician, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115. E-mail: aschaffer1@partners.org.

Click here to download the references for this educational activity.

The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited pre-test, a study activity, and a CME post-test. All 3 sections must be completed to receive CME credit.

Supported by an educational grant from Merck & Co., Inc.