NPPA and acute kidney injury: However, other studies reported that synthetic colloids were not associated with postoperative AKI [28] and that excessive fluid administration was associated with a greater risk of AKI because fluid overload may cause renal congestion; reduce renal perfusion and glomerular filtration; and induce atrial dilatation and stretching of blood vessel walls, causing the release of atrial natriuretic peptide (ANP) and damaging the endothelial glycocalyx (EGL), subsequently leading to AKI [29,30].