Advances in chronic kidney disease
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Adv Chronic Kidney Dis · Jan 2013
ReviewAn update on neurocritical care for the patient with kidney disease.
Patients with kidney disease have increased rates of neurologic illness such as intracerebral hemorrhage and ischemic stroke. The acute care of patients with critical neurologic illness and concomitant kidney disease requires unique management considerations including attention to hyponatremia, renal replacement modalities in the setting of high intracranial pressure, reversal of coagulopathy, and seizure management to achieve good neurologic outcomes.
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Adv Chronic Kidney Dis · Jan 2013
ReviewUpdates in the management of acute lung injury: a focus on the overlap between AKI and ARDS.
Acute respiratory distress syndrome (ARDS) is a major cause of hypoxemic respiratory failure in adults and can result from several predisposing factors, such as sepsis and trauma, which also predispose patients to acute kidney injury (AKI). Animal models of AKI and ARDS suggest that AKI increases inflammatory cytokines in the circulation such that IL-6 may be a direct mediator of AKI induced lung injury. ⋯ The cornerstone of therapy for ARDS continues to be low tidal volume ventilation, and more recent trials illustrate that diuretic administration to shock-free ARDS patients may help them avoid the deleterious effects of volume overload. This review focuses on new developments in the care of ARDS patients with a specific focus on interactions between the lungs and kidneys in patients with overlapping ARDS and AKI.
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Adv Chronic Kidney Dis · Jan 2013
ReviewUpdate in critical care for the nephrologist: transfusion in nonhemorrhaging critically ill patients.
A growing number of guidelines and recommendations advocate a restrictive transfusion strategy. Strong evidence exists that a hemoglobin threshold of less than 7 g/dL conserves resources and may improve outcomes in critically ill patients and that platelet counts greater than 10,000/μL are well tolerated. Patients with coronary artery disease can be safely managed with a restrictive transfusion strategy, utilizing a hemoglobin threshold of less than 7 or 8 g/dL; a threshold of less than 8 g/dL can be applied to patients with acute coronary syndromes. ⋯ Complications from transfusion are significant and previously under-recognized immunologic complications pose a more serious threat than infections. Erythropoietin and iron administration do not reduce transfusion needs in the critically ill. Interventions to reduce blood loss and educate clinicians are successful in reducing transfusion requirements.