Renal Physiology & Anesthesia
The kidneys play a vital role in regulating the volume and composition of body fluids, eliminating toxins, and elaborating hormones, including renin, eryth-ropoietin, and the active form of vitamin D. Factors directly and indirectly related to operative proce-dures and to anesthetic management frequently have a physiologically significant impact on renal physiology and renal function, and may lead to peri-operative fluid overload, hypovolemia, renal insuf-ficiency, and kidney failure, which are major causes of perioperative morbidity and mortality.
Diuretics are frequently used in the periopera-tive period. Diuretics are commonly administered on a chronic basis to patients with cardiovascular disease, including hypertension and chronic heart failure, and to patients with liver and kidney disease. Diuretics may be used intraoperatively, particu-larly during neurosurgical, cardiac, major vascular, ophthalmic, and urological procedures. Familiarity with the various types of diuretics, their mecha-nisms of action, side effects, and potential anesthetic interactions, is therefore essential.