Consideration of operative intervention in renal patients
Definitions
Mild CRF = GFR 60-90mls/min
Mod CRF = GFR 30-60mls/min
Sev CRF = GFR <30mls/min
Investigation
- Radio-contrast exposure
- May not be a problem for ESRF with patients on dialysis. But mild – moderate CRF that investifgation may knock off kidney function
Pre operative considerations
- Consider is there a need for the operation
- Balance of risk against other co morbid conditions
- Blood pressure and blood sugar trends
- 80% have hypertension.
- Beware intraoperative haemodynamic instability
- Diabetes may be a cause of CRF – predisposes patients to infection risk esp UTI’s
- Anaemia
- Erythtropoeitin production is effected
- Usually well tolerated
- Dec blood viscosity
- Inc Cardiac output
- Shift O2 dissociation curve to the right ( acidosis + 2,3DPG)
- CARE transfusion
- increase K+
- citrate toxicity – hypocalcaemia
- Coagulopathy
- Dialysis uses heparin ( ½ life is 1-2 hours)
- Platelet dysfunction ( defective von Willebrand’s factor)
- This is improved by dialysis + DDAVP
- Drugs
- Fluid status
- Needs to be normovolaemic
- Potential problems: Emergency cases / bowel prep can cause problematic fluid shifts
- Nutrition
- They are usually nutiritionally deficient (protein restricted diet)
- Susceptible to infection/ poor wound / anastamosis healing
- Hypo albuminaemai- odema / pulmonary oedema
- Functional capacity
- Ureamia
LINKS
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