• Khaschayar Saadat-Gilani and Alexander Zarbock.
• Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Germany.
• Curr Opin Anaesthesiol. 2021 Jun 1; 34 (3): 364372364-372.

Purpose Of ReviewAcute kidney injury (AKI) is underestimated but common in the perioperative setting. Although the association of this syndrome with an increased morbidity and mortality has been well established, little progress has been made in the diagnosis or prevention of AKI in recent years. This is partly due to the late detection of AKI by conventional criteria based of functional biomarkers, serum creatinine, and urine output. In addition, conceptually AKI is now recognized as being part of a continuum, in which preventive intervention is time critical. This review will summarize the current best available evidence and explain why timely perioperative management does have impact on the development of AKI and overall outcomes for patients.Recent FindingsDamage biomarkers can reliably identify AKI earlier than conventional functional biomarkers, facilitating more timely preventive intervention. Although the interventions published in the Kidney Disease: Improving Global Outcomes guideline are all important, the most relevant preventive options perioperatively include maintenance of adequate volume status and perfusion pressure, and the focus on balanced crystalloid solutions as maintenance fluid.SummaryAKI is a time critical syndrome that requires timely detection and damage biomarkers can help to adjust the perioperative management to prevent further injury.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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