Abstract
Cardiac surgery associated acute kidney injury is one of the most serious adverse events occurring in this population. To date, there are no widely accepted therapies for treating cardiac surgery associated acute kidney injury once it occurs; therefore, prevention is most important. Multiple therapies have been proposed for prevention of cardiac surgery associated acute kidney injury but none has been successful and uniformly adopted by anesthesia and surgical societies. In the review that follows, I propose a new approach to prevention of cardiac surgery associated acute kidney injury based upon a readily available marker of kidney function, urine flow rate. The relationship of urine flow rate to cardiac surgery associated acute kidney injury and the effects of raising urine flow rate with diuretics is discussed. The physiology behind the beneficial effects of high urine flow rate is applicable to other causes of acute kidney injury.