Anaesthesia for patients with chronic renal failure

Question 1

Animals with chronic renal disease may have the following, which will influence
anaesthesia or the way you deal with the anaesthetic?

Answer 1

o Anaemia. This will alter the animals oxygen carrying capacity, the onset of
cyanosis being visible, and binding of drugs.
o Hypoalbuminaemia (if a protein losing nephropathy) will influence drug binding
o Calcium-phosphorus derangements may predispose to arrhythmias
o Chronic hypertension, may lead to cardiomegaly, ventricular hypertrophy, and
coronary arteriolar hypertrophy.
o Bleeding tendencies from bone marrow depression and poor liver function
o Nausea and vomiting from uraemia may also predispose to acid base
abnormalities
o Immunosuppression (from bone marrow suppression), so more care with
catheters.
o Altered drug behaviour (from reasons above) and also decreased renal excretion
of some drugs, especially active metabolites.

Question 2

Anaesthesia and certain drugs can be detrimental to kidney function. In a renal
compromised patient, we need to minimize or prevent further damage caused. One of
the main aims of anaesthesia in renal patients is?

Answer 2

maintaining renal blood flow and
oxygenation of the renal tissue

Question 3

The kidneys rely on certain prostaglandins such as PGI2 and PGE2 (amongst
other substances) to maintain renal blood flow in times of low blood pressure –
so avoid?

Answer 3

NSAIDs (which block prostaglandin production)