{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:46:16Z","timestamp":1787755576898,"version":"build-2784847793"},"reference-count":78,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JBJS Rev"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:p>\n                    <jats:list list-type=\"plain\">\n                      <jats:list-item>\n                        <jats:p>\u00bb Acute kidney injury, defined as an increase in serum creatinine of 0.3 mg\/dL or &gt;50% of baseline or sustained oliguria with urine output of &lt;0.5 mL\/kg\/hr for &gt;6 hours, affects 2% to 15% of patients undergoing lower-extremity joint arthroplasty. Patients who develop acute kidney injury have an increased length of hospitalization and a greater cost of care, are less likely to be discharged home postoperatively, and have increased short-term and long-term mortality.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u00bb Risk factors for acute kidney injury after lower-extremity joint arthroplasty include older age, male sex, obesity, diabetes, hypertension, congestive heart failure, and especially underlying chronic kidney disease.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u00bb Consensus guidelines have not been updated to reflect recent research into the perioperative effects on angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs); most patients taking these medications chronically without systolic heart failure should omit the dose prior to the surgical procedure to reduce the risk of perioperative hypotension and acute kidney injury.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u00bb In patients at an increased risk for acute kidney injury, efforts should be made when clinically appropriate to minimize exposure to potential nephrotoxins including nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 (COX-2) inhibitors, intravenous computed tomography (CT) contrast, and antibiotics with higher rates of nephrotoxicity such as vancomycin and aminoglycosides.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u00bb The initial evaluation for patients developing acute kidney injury after lower-extremity joint arthroplasty should include ruling out urinary obstruction, clinical volume status assessment, determining whether intraoperative or postoperative hypotension has occurred, urinalysis, and urine electrolyte studies.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:p>","DOI":"10.2106\/jbjs.rvw.18.00121","type":"journal-article","created":{"date-parts":[[2019,5,2]],"date-time":"2019-05-02T07:37:05Z","timestamp":1556782625000},"page":"e9-e9","source":"Crossref","is-referenced-by-count":4,"title":["Acute Kidney Injury in Lower-Extremity Joint Arthroplasty"],"prefix":"10.2106","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1917-4110","authenticated-orcid":false,"given":"Michael D.","family":"Rudy","sequence":"first","affiliation":[{"name":"Division of Hospital Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2979-7530","authenticated-orcid":false,"given":"Neera 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