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
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
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