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Postoperative complications Tone increased by noradrenaline and subject to autoregulation Afferent arteriole Distal tubule Macula densa of distal tubule Efferent arteriole Tone increased by angiotensin II Juxtaglomerular cells (modified smooth muscle) Bowmans capsule (parietal layer) Urinary space Bowmans capsule (visceral layer podocytes) Proximal convoluted tubule A rising creatinine perioperatively therefore indicates acute renal impairment, and that the pathology may be: Prerenal failure (hypoperfusion) Hypotension or shock (hypovolaemia, cardiogenic, septic) Renal artery disease or obstruction Renal (direct injury) Glomerular: glomerulonephritis diabetes mellitus amyloidosis Tubulointerstitial: acute tubular necrosis (follows prerenal failure, aminoglycosides, contrast medium, myoglobin) acute cortical necrosis (pre-eclampsia, septic abortion, placental abruption) interstitial nephritis (antibiotics) Vascular: connective tissue disease hypertension 26 231 Secondary Electron Microscopy in Pharmaceutical Technology 3235 Fig.
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