Advances in chronic kidney disease
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Sepsis and septic shock are syndromes that overlap between several disciplines and subspecialties. Emerging evidence suggests that sepsis may be associated with short- and long-term adverse outcomes, even when the syndrome does not appear to be severe and is not managed in the intensive care unit. Hence, all practicing clinicians need to be familiar with the fundamental principles of diagnosis and management of sepsis. In this review, we have summarized the key components in the management of sepsis/septic shock, including early recognition, early resuscitation, principles of antibiotic therapy, organ support, and role of adjunctive therapies.
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Nephrologists and critical care physicians are commonly involved in the treatment of severely poisoned patients. Various techniques exist presently to enhance the elimination of poisons. ⋯ Extracorporeal treatments include hemodialysis, hemoperfusion, peritoneal dialysis, continuous renal replacement therapy, exchange transfusion, and plasmapheresis. This review illustrates the potential indications and limitations in the application of these modalities as well as the pharmacological characteristics of poisons amenable to enhanced elimination.
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The incidence of acute kidney injury (AKI) is generally 5-7.5% in all acute care hospitalizations and accounts for up to 20% of admissions to intensive care units (ICUs). Of all of the cases of AKI during hospitalization, approximately 30-40% are observed in operative settings. AKI is a serious morbidity that is associated with greater length of hospital stay, high risk of hospital mortality, and increased risk of incident and progressive chronic kidney disease. ⋯ With limited treatment options, prevention of AKI and amelioration of its severity remain important cornerstones of improving patient outcomes. The magnitude of the problem and the unique set of patient characteristics calls for a multidisciplinary approach for the perioperative management of renal complications. The purpose of the review presented here is to discuss the current knowledge regarding the epidemiology and risk factors, outcomes, diagnoses, and prevention and treatment of AKI during the perioperative period in cardiovascular and noncardiovascular surgical settings.
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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.