Renal protection

While considerable progress has been made in the understanding of renal injury in the context of major vascular surgery, successful strategies for providing renal protection still remain elusive. The literature is disappointingly unenlightening, as adequately powered clinical trials evaluating approaches to peri-operative renal protection are lacking. Consequently, a considerable proportion of commonly employed practices aimed at preserving the kidney are based on small studies, anecdotal information or personal experience. This chapter will attempt to summarize what actually is known about peri-operative renal injury, identifying patients who are at high risk and procedures that place patients at high risk, and reviewing the current practices for renal protection in those settings. We will then consider both theoretical and experimental approaches to preventing or attenuating renal injury in patients at risk. Finally, we will suggest techniques, based on the best available evidence, for providing renal protection for our patients undergoing major vascular surgery.