1,721,187 research outputs found
Year in review: Critical Care 2004 - nephrology
No full textWe summarize all original research in the field of critical care nephrology published in 2004 or accepted for publication in Critical Care and, when considered relevant or directly linked to this research, in other journals. Articles were grouped into four categories to facilitate a rapid overview. First, regarding the definition of acute renal failure (ARF), the RIFLE criteria ( risk, injury, failure, loss, ESKD [end-stage kidney disease]) for diagnosis of ARF were defined by the Acute Dialysis Quality Initiative workgroup and applied in clinical practice by some authors. The second category is acid - base disorders in ARF; the Stewart Figge quantitative approach to acidosis in critically ill patients has been utilized by two groups of researchers, with similar results but different conclusions. In the third category - blood markers during ARF - cystatin C as an early marker of ARF and procalcitonin as a sepsis marker during continuous venovenous haemofiltration were examined. Finally, in the extracorporeal treatment of ARF, the ability of two types of high cutoff haemofilters to influence blood levels of middle- and high-molecular-weight toxins showed promise
Timing, dose and mode of dialysis in acute kidney injury
No full textPurpose of review In the past 3 years substantial progress has been made in the field of renal replacement therapy (RRT) for critically ill patients. Recent findings Two important multicenter randomized clinical trials have been recently published and extensively discussed: the randomized evaluation of normal versus augmented level (RENAL) replacement therapy study and the VA/NIH Acute Renal Failure Trial Network (ATN) study. The RENAL and ATN studies were designed to compare 'normal' or 'less intensive' renal support to an 'augmented' or 'intensive' therapy: both studies showed no benefit in outcomes by increases in intensity of RRT dose. The definition of 'normal dose' is now recommended in a range of 20-30 ml/kg per h for continuous therapies and/or thrice weekly intermittent hemodialysis. On the contrary, the complex issue of RRT optimal timing still remains uncertain and controversial. Summary Wide variations in clinical practice still require RRT for critically ill patients to be optimized. The ideal prescription does not exist; however, continuous hemofiltration at a dose of 30 ml/kg/h meets many requirements of optimal care. In order to shed some light in the issue of RRT timing, furthermore, in the near future a standardized and clinically relevant definition of 'early' RRT should be provided. Great expectations currently rely on the utilization of acute kidney injury severity classifications and on new biomarkers of renal function
DIALYSIS Preventing hypophosphatemia during pediatric CRRT
No full textA recent report showed that hypophosphatemia is common in children undergoing continuous renal replacement therapy, and that adding phosphate to the replacement and dialysate solutions significantly reduced the incidence of this complication. should such supplementation be routinely performed
Pulmonary/renal interaction (Retracted article. See vol. 18, pg. 294, 2012)
No full textPurpose of review Acute kidney injury contributes to the development of acute lung injury and vice-versa. Volume overload that may occur during renal impairment increases pulmonary capillary hydrostatic pressure. However, experimental evidence clearly shows that lung damage occurs even in the absence of positive fluid balance. However, acute lung injury with its attendant hypoxemia, hypercapnia and mechanical ventilation worsens renal hemodynamics and function. Recent findings An increasing body of evidence suggests that kidney and lung interact (crosstalk) during severe insults, such as shock, trauma, and sepsis, due to a loss of the normal balance of immune, inflammatory and soluble mediators. Kidney-lung crosstalk in the critically ill constitutes a possibility to analyze mechanisms of multiple organ failure in which the kidney and the lung can play an important role. Consequently, on the clinical side, specific therapeutic options can be hypothesized for kidney/lung dysfunction. Summary Fluid management optimization and prevention of inflammation and lung stretching are currently recommended for the treatment of acute lung and renal injury. Extracorporeal CO2 removal and renal replacement associated with extracorporeal membrane oxygenation might be interesting options for a future approach to pulmonary/renal syndrome
Year in review 2005: Critical Care - Nephrology
No full textWe summarize original research in the field of critical care nephrology accepted or published in 2005 in Critical Care and, when considered relevant or directly linked to this research, in other journals. The articles have been grouped into four categories to facilitate a rapid overview. First, physiopathology, epidemiology and prognosis of acute renal failure (ARF): an extensive review and some observational studies have been performed with the aim of describing aspects of ARF physiopathology, precise epidemiology and long-term outcomes. Second, several authors have performed clinical trials utilizing a potential nephro-protective drug, fenoldopam, with different results. Third, the issue of continuous renal replacement therapies dose has been addressed in a small prospective study and a large observational trial. And fourth, alternative indications to extracorporeal treatment of ARF and systemic inflammatory response syndrome have been explored by three original clinical studies
Pathogenesis of Acute Kidney Injury During Sepsis
No full textSeptic acute kidney injury (AKI) occurs between 15% and 20% of all intensive care unit admissions and its mortality ranges from 20% to 60%. The incidence and mortality of septic AKI has remained high throughout the last 10 years, whereas our understanding of septic AKI pathogenesis has remained limited. Current evidence about the pathophysiology of septic AKI will be reviewed and areas that require further investigation will be discussed. Improvement of knowledge about this condition seems to be most important in order to find valid diagnostic exams to exactly identify septic AKI and effective therapies to treat it: both of them are currently lacking. Finally, new preventive strategies might be experimented in order to protect critically ill patients from septic AKI
Renal replacement II: Dialysis dose
No full textImproved survival of critically ill acute renal failure patients can be correlated with therapy dose. The overall solute elimination can be measured by the product of clearance and time (Kt), which is usually normalized for the volume of distribution (V) of the solute as "Kt/V." Setting a Kt/V threshold of 1.4 can guide clinicians toward adequate treatment. This is a slightly higher prescription than the current value for chronic dialysis. However, the true uraemic toxins probably diffuse among body compartments less readily than urea and, as such, the frequency of renal replacement therapy should be more important to its efficiency, and should be optimal with continuous therapy. In the absence of an optimal dialysis dose, it can only be recommended that the prescription should exceed that calculated to be "adequate.
Year in review 2007: Critical Care - nephrology
No full textWe summarize original research in the field of critical care nephrology that was accepted for publication or published in 2007 in Critical Care and, when considered relevant or directly linked to this research, in other journals. Four main topics were identified for a brief overview. The first of these was the definition of acute kidney injury and recent evidence showing the validity of RIFLE (Risk, Injury, Failure, Loss and End-stage kidney disease) criteria and the recent Acute Kidney Injury Network review of the same criteria. Second, we cover the clinical and experimental utilization of novel biomarkers for diagnosis of acute kidney injury, giving special attention to neutrophil gelatinase-associated lipocalin protein. The third area selected for review is outcomes of acute kidney injury during the past 10 years, described by a recent Austrailian epidemiological study. Finally, specific technical features of renal replacement therapies were examined in 2007, specifically regarding anticoagulation and vascular access
Today's Approach to the Critically III Patient with Acute Kidney Injury
No full textThe present review describes recent evidence on all aspects relating to acute kidney injury (AKI): epidemiology, definition, diagnosis, medical and extracorporeal therapy. AKI is often underrecognized, but its outcome still remains unfavorable. In this light, definition, classification and diagnosis of AKI are fundamental today and may be reliably based on recently proposed RIFLE (risk, injury, failure, loss of function, end-stage kidney disease) classification. Pharmacological therapy of AKI is still scarcely effective, but renal replacement therapy has progressed to a more accurate and safe treatment and new interesting high-level trials and observational studies have been performed and are reviewed and commented. In the near future, however, only increased awareness of AKI incidence and early treatment or prevention of kidney injury progression will hopefully improve outcome of critically ill patients with renal failure. Copyright (C) 2009 S. Karger AG, Base
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