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Anaesthesiology

Anaesthesia of the patient with chronic kidney disease

02 December 2020
Clinical
19 mins read
02 October 2020
Volume 25 · Issue 11

Abstract

Chronic kidney disease is common, particularly in geriatric animals. General anaesthesia is usually required for routine procedures (dental prophylaxis, ovariohysterectomy or castration) and emergency procedures, which may have profound effects on the body, especially on cardiac output, subsequent blood pressure and on the perfusion of different vital organs. It is essential to understand the effects of renal dysfunction on the patient, as well as the effects that anaesthesia and surgery may have on the kidneys. The understanding of renal physiology, along with the effect of drug choices, is key to successful management of chronic renal failure.

The kidneys are complex multifunctional organs which control multiple different functions, all of which can be affected by anaesthesia. The main functions are regulation of water balance (blood volume, osmolarity (Na+) and blood pressure), regulation of electrolyte balance (sodium, potassium, calcium and phosphate), regulation of blood pH (acid (H+), excretion, bicarbonate, reabsorption) and gluconeogenesis. The kidneys also excrete waste products and toxins and eliminate drugs via filtration or secretion into urine. In addition to the functions previously mentioned, the kidneys play an important role in endocrine functions. These include the control of red blood cell production by synthesis of erythropoietin, renin production and 1,25-dihydroxycholecalciferol, the active form of vitamin D (Hall, 2015).

In order to fulfil all its functions, each kidney filters a large amount of water and solutes from the blood, reabsorbing the substances needed and secreting the waste products into the convoluted tubules (Schroeder, 2014).

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anaesthesia
canine
chronic
geriatric
failure
feline kidney