LAUSR

Acute kidney injury is a common and significant complication following ileostomy formation. loria et al. [2] Ileostomy formation remains a common component of colorectal surgery whether for cancer, IBD or functional disorders. Balancing the risks of ileostomy formation and its sequelae against alternative management strategies remains a key judgement call for colorectal surgeons. The colorectal community has long known of the impact of dehydration that results from a high output stoma, but there are challenges with the subjective clinical assessment of dehydration for research purposes. The development of acute kidney injury (AKI) defined and by graded according to KDIGO criteria is more objective, however its development during index surgery and its relation to patient outcomes has not previously been studied. In this month's Colorectal Disease Loria et al. examine the relationship between index admission AKI development, complications and readmission, specifically dehydration related readmission. The results necessitate reflection about how we counsel patients as part of the informed consent process. In a UK context (although common ethical principles apply globally) the 2015 Supreme Court ruling in the Nadine Montgomery vs. NHS Lanarkshire case emphasized that doctors must provide information about all material risks; they must disclose any risk to which a reasonable person in the patient's position would attach significance. Given that Loria et al have highlighted the impact of AKI on many of the components of the core information set for colorectal cancer surgery [1] it is time to bring this complication to the fore in our discussions with patients prior to surgery.