1,721,051 research outputs found
Acute kidney injury in the intensive care unit: Current trends in incidence and outcome
No full textAcute kidney injury (AKI) is a common clinical problem with significant clinical and economic consequences. A number of studies point to a rising incidence of AKI in the hospital and in the intensive care unit over the past several years, and an increase in the degree of co-morbidity associated with it. Recent evidence suggests that there has been some improvement in outcomes over time. Nevertheless, the mortality associated with AKI remains unacceptably high, and further work is needed. Recently developed consensus definitions will be useful in this regard
Classification and staging of acute kidney injury: beyond the RIFLE and AKIN criteria
No full textAcute kidney injury (AKI) is often overlooked in hospitalized patients, despite the fact that even mild forms are strongly associated with poor clinical outcomes such as increased mortality, morbidity, cardiovascular failure and infections. Research endorsed by the Acute Dialysis Quality Initiative led to the publication of a consensus definition for AKI-the RIFLE criteria (Risk, Injury, Failure, Loss of function, and End-stage renal disease)-which was designed to standardize and classify renal dysfunction. These criteria, along with revised versions developed by the AKI Network (AKIN), can detect AKI with high sensitivity and high specificity and describe different severity levels that aim to predict the prognosis of affected patients. The RIFLE and AKIN criteria are easy to use in a variety of clinical and research settings, but have several limitations: both utilize an increase in serum creatinine level from a hypothetical baseline value and a decrease in urine output, but these surrogate markers of renal impairment manifest relatively late after injury has occurred and do not consider the nature or site of the kidney injury. New biomarkers for AKI have shown promise for early diagnosis and prediction of the prognosis of AKI. As more data become available, they could, in the future, be incorporated into improved definitions or criteria for AKI
Oxidative stress and anemia in chronic hemodialysis: The promise of bioreactive membranes
No full textPatients with advanced chronic kidney disease are characterized by an imbalance between pro- and antioxidant factors, and increased oxidative stress has been associated with complications of end-stage renal disease such as atherosclerosis, beta(2)-Microglobulin amyloidosis and anemia. Antioxidants such as vitamin E work by inhibiting LDL oxidation by oxidants and by limiting cellular response to oxidized LDL, and are potentially useful adjuncts to the usual medical therapy provided to such patients. In chronic hemodialysis (HD) patients, vitamin E therapy may be administered in the form of dietary supplementation, or as an integral part of the HD procedure in the form of bioreactive dialysis membranes, in which the blood surface has been modified with a-tocopherol. Since blood membrane interaction plays a key role in generating oxidative stress, direct free radical scavenging at the membrane site is a logical approach. Dialysis with vitamin E-coated membranes (VECM) is associated with an improvement in circulating biomarkers of lipid peroxidation. Other than antioxidant activity, the modified surface appears to render these dialyzers more biocompatible, in that cellulose-based membranes behave similar to synthetic dialyzers in terms of cytokine induction. In small studies in chromic HD patients, both dietary vitamin E supplementation as well as use of VECM have been associated with reduced RBC fragility, prolonged RBC lifespan, and improvements in hemoglobin and rHuEpo requirements. Newer VECM based on polysulfone bring us further down the road towards complete biocompatibility, and represent a promising therapy against oxidative stress in chronic HD patients. Copyright (c) 2008 S. Karger AG, Basel
Clinical review: RIFLE and AKIN - time for reappraisal
Full text linkIn recent years, the use of the consensus definitions of acute kidney injury (RIFLE and AKIN) in the literature has increased substantially. This indicates a highly encouraging acceptance by the medical community of a unifying definition for acute kidney injury. This is a very important and positive step in the right direction. There remains some variation in how the criteria are interpreted and used in the literature, including use/nonuse of urine output criteria, use of change in estimated glomerular filtration rate rather than change in creatinine, and choice of baseline creatinine. The present review is intended to aid the reader in critically appraising studies using these consensus definitions. Since no single definition will be perfect, a logical next step would be to reconcile existing definitions, moving the medical community towards using a single consensus definition as has been done with sepsis and acute lung injury/acute respiratory distress syndrome. As new data emerge, integration of novel biomarkers into the consensus definition will be a welcome refinement
Cardiorenal syndromes
No full textPurpose of review The purpose of the present review is to identify the mechanisms involved in the syndrome related to combined heart-kidney dysfunction. Recent findings The bidirectionality of the syndrome and the various time frames involved in the different clinical pictures have induced to generate a new definition of the cardiorenal syndrome, focusing on five specific subtypes (acute cardiorenal syndrome, type 1; chronic cardiorenal syndrome, type 2; acute renocardiac syndrome, type 3; chronic renocardiac syndrome, type 4; and secondary cardiorenal syndrome, type 5). Summary The new definition allows to characterize the various clinical scenarios and to identify patients with different subtypes in which the primary disorder and the sequelae are clearly described. Biomarkers for early diagnosis of heart and kidney dysfunction may further contribute to a clearer definition of the disorder. The new classification will allow to test diagnostic tools and prevention strategies as well as therapeutic measures that in the past might not have been applied properly due to the lack of a consistent classification of the syndrome
Clinical effects of polymyxin B-immobilized fiber column in septic patients
No full textEndotoxin is one of the principal biological substances that cause gram-negative septic shock. Lack of clinical success with antiendotoxin or anticytokine therapy has shifted interest to extracorporeal therapies to reduce circulating levels of the mediators of sepsis. Direct hemoperfusion with polymyxin-B-immobilized fiber (PMX-F) is a promising treatment of gram-negative sepsis in critically ill patients. Because of the high affinity of polymyxin B for endotoxin, the rationale underlying extracorporeal therapy would be to remove circulating endotoxin by adsorption, thus preventing progression of the biological cascade of sepsis. In a systematic review of 28 studies (pooled sample size 1,390 patients), the preliminary results of which are described here, PMX-F therapy appeared to significantly tower endotoxin levels, improve blood pressure, and reduce mortality. However, publication bias and lack of blinding need to be considered. These encouraging results need to be verified with large-scale controlled clinical trials. (C) Copyright C 2007 S. Karger AG, Basel
Hospital-acquired acute kidney injury in the elderly
No full textAcute kidney injury (AKI) is becoming increasingly common in elderly individuals. The presence of multiple comorbidities as well as age-related changes in the kidney, systemic vasculature and immunological system render older patients more prone to renal injury. Hypovolemia, sepsis, and iatrogenic complications related to drug toxicity, contrast-induced nephropathy, and perioperative complications therefore often occur in older hospitalized patients. Although AKI is treated in the same way in elderly individuals and younger patients, elderly individuals are more vulnerable to dialysis-related complications such as hemodynamic instability, bleeding, and mild disequilibrium syndrome. Strategies for the prevention of AKI are particularly important in these fragile patients, but making an early diagnosis is especially challenging in this age group
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