scholarly journals Estimating Kidney Function in the Critically Ill Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Gemma Seller-Pérez ◽  
Manuel E. Herrera-Gutiérrez ◽  
Javier Maynar-Moliner ◽  
José A. Sánchez-Izquierdo-Riera ◽  
Anibal Marinho ◽  
...  
Keyword(s):  
Critically Ill ◽  
Kidney Function ◽  
Kidney Injury ◽  
Laboratory Method ◽  
Urine Flow ◽  
Critically Ill Patient ◽  
Functional Evaluation ◽  
Common Definition ◽  
Definition Of ◽  
Near Future

Glomerular filtration rate (GFR) is an accepted measure for assessment of kidney function. For the critically ill patient, creatinine clearance is the method of reference for the estimation of the GFR, although this is often not measured but estimated by equations (i.e., Cockroft-Gault or MDRD) not well suited for the critically ill patient. Functional evaluation of the kidney rests in serum creatinine (Crs) that is subjected to multiple external factors, especially relevant overhydration and loss of muscle mass. The laboratory method used introduces variations in Crs, an important fact considering that small increases in Crs have serious repercussion on the prognosis of patients. Efforts directed to stratify the risk of acute kidney injury (AKI) have crystallized in the RIFLE or AKIN systems, based in sequential changes in Crs or urine flow. These systems have provided a common definition of AKI and, due to their sensitivity, have meant a considerable advantage for the clinical practice but, on the other side, have introduced an uncertainty in clinical research because of potentially overestimating AKI incidence. Another significant drawback is the unavoidable period of time needed before a patient is classified, and this is perhaps the problem to be overcome in the near future.

scholarly journals ACUTE KIDNEY INJURY DURING CRITICAL ILLNESS – A GLOBAL CHALLENGE

2019 ◽  
Vol 16 (2) ◽  
pp. 83-95
Author(s):  
M. Ostermann
Keyword(s):  
Acute Kidney Injury ◽  
Drug Therapy ◽  
Critically Ill ◽  
Kidney Injury ◽  
Critically Ill Patient ◽  
Infusion Therapy ◽  
Global Challenge ◽  
Nephrotoxic Drugs ◽  
Definition Of

The report is devoted to the problem of acute kidney injury (AKI) in critically ill patients. Currently, the clinical definition of AKI is based on the assessment of increasing serum creatinine, but this method has a number of significant drawbacks. Perhaps the use of biomarkers for early detection of renal injury will improve diagnostic results. Up to date, no specific drug therapy for AKI has no available. The therapeutic tactics are based on the assessment of the risk of development AKI in critically ill patient, hemodynamic optimization, revision of drug therapy to exclude nephrotoxic drugs and the use of renal replacement therapy (RRT). Despite the numerous studies and the presence of multiple researches of AKI, there are many unclear issues related, for example, how to choose tactics of infusion therapy, the use of vasopressor support in patients with AKI, the time of the beginning and the choice of the mode of RRT, the feasibility of combining several technologies of extracorporeal hemocorrection. It is important to define how to improve the short-term prognosis and the long-term consequences of renal dysfunction.

scholarly journals Impact of Renal Replacement Therapy on Mortality in Critically Ill Patients—The Nephrologist’s View within an Interdisciplinary Intensive Care Team

2021 ◽  
Vol 10 (15) ◽  
pp. 3379
Author(s):  
Matthias Klingele ◽  
Lea Baerens
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Impact ◽  
Kidney Injury ◽  
Care Team ◽  
Critically Ill Patient ◽  
Late Start

Acute kidney injury (AKI) is a common complication in critically ill patients with an incidence of up to 50% in intensive care patients. The mortality of patients with AKI requiring dialysis in the intensive care unit is up to 50%, especially in the context of sepsis. Different approaches have been undertaken to reduce this high mortality by changing modalities and techniques of renal replacement therapy: an early versus a late start of dialysis, high versus low dialysate flows, intermittent versus continuous dialysis, anticoagulation with citrate or heparin, the use of adsorber or special filters in case of sepsis. Although in smaller studies some of these approaches seemed to have a positive impact on the reduction of mortality, in larger studies these effects could not been reproduced. This raises the question of whether there exists any impact of renal replacement therapy on mortality in critically ill patients—beyond an undeniable impact on uremia, hyperkalemia and/or hypervolemia. Indeed, this is one of the essential challenges of a nephrologist within an interdisciplinary intensive care team: according to the individual situation of a critically ill patient the main indication of dialysis has to be identified and all parameters of dialysis have to be individually chosen with respect to the patient’s situation and targeting the main dialysis indication. Such an interdisciplinary and individual approach would probably be able to reduce mortality in critically ill patients with dialysis requiring AKI.

Urine Quantification Following Furosemide for Severe Acute Kidney Injury Prediction in Critically Ill Children

2021 ◽  
Author(s):  
Katja M. Gist ◽  
Jamie Penk ◽  
Eric L. Wald ◽  
Laura Kitzmiller ◽  
Tennille N. Webb ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Critically Ill ◽  
Flow Rate ◽  
Kidney Injury ◽  
Urine Flow ◽  
Urine Flow Rate ◽  
Critically Ill Children ◽  
Prospective Assessment ◽  
Critically Ill Adults

AbstractA standardized, quantified assessment of furosemide responsiveness predicts acute kidney injury (AKI) in children after cardiac surgery and AKI progression in critically ill adults. The purpose of this study was to determine if response to furosemide is predictive of severe AKI in critically ill children outside of cardiac surgery. We performed a multicenter retrospective study of critically ill children. Quantification of furosemide response was based on urine flow rate (normalized for weight) measurement 0 to 6 hours after the dose. The primary outcome was presence of creatinine defined severe AKI (Kidney Disease Improving Global Outcomes stage 2 or greater) within 7 days of furosemide administration. Secondary outcomes included mortality, duration of mechanical ventilation and length of stay. A total of 110 patients were analyzed. Severe AKI occurred in 20% (n = 22). Both 2- and 6-hour urine flow rate were significantly lower in those with severe AKI compared with no AKI (p = 0.002 and p < 0.001). Cutoffs for 2- and 6-hour urine flow rate for prediction of severe AKI were <4 and <3 mL/kg/hour, respectively. The adjusted odds of developing severe AKI for 2-hour urine flow rate of <4 mL/kg/hour was 4.3 (95% confidence interval [CI]: 1.33–14.15; p = 0.02). The adjusted odds of developing severe AKI for 6-hour urine flow rate of <3 mL/kg/hour was 6.19 (95% CI: 1.85–20.70; p = 0.003). Urine flow rate in response to furosemide is predictive of severe AKI in critically ill children. A prospective assessment of urine flow rate in response to furosemide for predicting subsequent severe AKI is warranted.

Mannitol in the Critically Ill Patient with Acute Kidney Injury

2012 ◽  
pp. 1356-1359
Author(s):  
Denis D. Bensard ◽  
Philip F. Stahel ◽  
Jorge Cerdá ◽  
Babak Sarani ◽  
Sajid Shahul ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Critically Ill Patient

Acute kidney injury and electrolyte disorders in the critically ill patient with cancer

2017 ◽  
Vol 23 (6) ◽  
pp. 475-483 ◽  
Author(s):  
Mitchell H. Rosner ◽  
Giovambattista Capasso ◽  
Mark A. Perazella
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Critically Ill Patient ◽  
Electrolyte Disorders
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