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Perioperative AKI Prevention AAA — ESENeph MCQ

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ModerateAcute Kidney InjuryPerioperative AKI Prevention AAAESENeph

A 55-year-old man with CKD G3b has been found to have an abdominal aortic aneurysm (5.8 cm). He needs elective repair. His eGFR is 35 mL/min/1.73m2. What perioperative renal considerations are important?

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Correct answer: C — High risk of perioperative AKI; optimise hydration, avoid nephrotoxins, ensure renal-dose contrast if endovascular repair, monitor renal function post-operatively, and hold RASi/SGLT2i on day of surgery

Patients with CKD undergoing major vascular surgery (particularly AAA repair) have significantly increased perioperative AKI risk. Risk mitigation includes: adequate IV hydration peri-operatively, minimising contrast volume (if EVAR), holding RASi and SGLT2i on the operative day (to reduce haemodynamic AKI risk), avoiding nephrotoxins (NSAIDs, aminoglycosides), and post-operative renal function monitoring. CKD itself is not a contraindication to surgery but increases the risk profile.

Reference: NICE AKI Pathway 2019; KDIGO 2012 – AKI; ESVS 2024 – AAA Guidelines