Renal failure Post AAA Repair

OVERVIEW

  • Numerous possible causes of Renal failure Post Abdominal aortic aneurysm repair

CAUSES

Pre-renal

  • Hypovolaemia causing pre-renal failure
  • Abdominal compartment syndrome
  • Renal artery trauma
  • Low output state (1) myocardial dysfunction from cross clamping, (2) perioperative ischaemia
  • Post-operative bleeding
  • Ischaemic rhabdomyolysis
  • Perioperative ischaemia due to clamp – turbulent (infrarenal clamp) or no (suprarenal clamp) renal blood flow
  • Embolisation of plaque during endovascular procedure
  • Sepsis (inadvertent bowel ischaemia )

Renal

  • Contrast nephropathy (contrast used during endovascular procedures)
  • Administration of nephrotoxic agents – pre or intraoperatively (ACE-inhibitors, aminoglycosides)
  • underlying intrinsic renal disease

Post-renal

  • blocked catheter
  • ureteric injury

MANAGEMENT

  • ensure patent urinary catheter and urine output measurement
  • ensure euvolemia and optimise cardiac function
  • cease all nephrotoxins
  • renal replacement therapy if indicated
  • seek (blood tests, imaging) and treat underlying cause (e.g. interventions to ensure renal vascular supply, treat rhabdomyolysis)

References and Links


CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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