Perioperative organ injury is among the leading causes of morbidity and mortality of surgical patients. Among different types of perioperative organ injury,
acute kidney injury occurs particularly frequently and has an exceptionally detrimental effect on surgical outcomes. Currently,
acute kidney injury is most commonly diagnosed by assessing increases in serum
creatinine concentration or decreased urine output. Recently, novel
biomarkers have become a focus of translational research for improving timely detection and prognosis for
acute kidney injury. However, specificity and timing of
biomarker release continue to present challenges to their integration into existing diagnostic regimens. Despite many clinical trials using various pharmacologic or nonpharmacologic interventions, reliable means to prevent or reverse
acute kidney injury are still lacking. Nevertheless, several recent randomized multicenter trials provide new insights into renal replacement strategies, composition of intravenous fluid replacement, goal-directed
fluid therapy, or remote ischemic preconditioning in their impact on perioperative
acute kidney injury. This review provides an update on the latest progress toward the understanding of disease mechanism, diagnosis, and managing perioperative
acute kidney injury, as well as highlights areas of ongoing research efforts for preventing and treating
acute kidney injury in surgical patients.