Kidney international
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Kidney international · Jun 2012
Multicenter StudySome biomarkers of acute kidney injury are increased in pre-renal acute injury.
Pre-renal acute kidney injury (AKI) is assumed to represent a physiological response to underperfusion. Its diagnosis is retrospective after a transient rise in plasma creatinine, usually associated with evidence of altered tubular transport, particularly that of sodium. In order to test whether pre-renal AKI is reversible because injury is less severe than that of sustained AKI, we measured urinary biomarkers of injury (cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), γ-glutamyl transpeptidase, IL-18, and kidney injury molecule-1 (KIM-1)) at 0, 12, and 24 h following ICU admission. ⋯ The median concentration of at least one biomarker was increased in all but three patients with pre-renal AKI. Thus, the reason why some but not all biomarkers were increased requires further study. The results suggest that pre-renal AKI represents a milder form of injury.
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Monitoring the quality of dialysis care has long been a component of the Medicare ESRD program. As part of the 2008 Medicare Improvements for Patients and Providers Act (MIPPA), Congress mandated the Quality Incentive Program (QIP), which linked measures of care quality to payments. ⋯ For payment year 2014 (performance period calendar year 2012), the program changes substantially, with an expanded number of quality measures and a more complex scoring methodology. In this article, we describe the program structure, quality measures, scoring system, and financial impact.
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Kidney international · Jun 2012
ReviewICU nephrology: the implications of cardiovascular alterations in the acutely ill.
Cardiovascular alterations are common in critically ill patients and can have important implications for multiple organ systems, including the kidney. Restoring and maintaining adequate hemodynamic status in such patients is crucial to ensure sufficient oxygen availability to tissues and organs so that they can function optimally. In this text, we will return to the basic physiology of cardiac output and its components so that we can better understand the effects of cardiovascular alterations in critically ill patients, and how best to treat them.
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Patients cared for in the intensive care unit (ICU) undergo multiple interventions to treat serious medical conditions. In addition to the acute illness being treated, underlying chronic conditions require ongoing drug therapy. As a result, these patients are exposed to numerous pharmaceutical agents, many of which have narrow therapeutic windows and toxic potential. ⋯ One such complication is acute kidney injury (AKI), a relatively common problem in the ICU, which results from multiple insults. Importantly, potentially nephrotoxic medications contribute significantly to the development of AKI. In view of these issues, it is crucial that clinicians caring for these patients use appropriate drug dosing based on the knowledge of altered pharmacokinetics, vigilant monitoring of drug efficacy and toxicity, recognition of drugs with nephrotoxic potential, and early identification of drug-induced AKI when it develops.