Critical care clinics
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Acute kidney injury is a frequent complication of acute heart failure syndromes, portending an adverse prognosis. Acute cardiorenal syndrome represents a unique form of acute kidney injury specific to acute heart failure syndromes. ⋯ Biomarkers reflecting different aspects of acute cardiorenal syndrome pathophysiology may allow patient phenotyping to inform prognosis and treatment. Adjunctive vasoactive, neurohormonal, and diuretic therapies may relieve congestive symptoms and/or improve renal function, but no single therapy has been proved to reduce mortality in acute cardiorenal syndrome.
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The concentration of hydrogen ions is regulated in biologic solutions. There are currently 3 recognized approaches to assess changes in acid base status. ⋯ The third approach is the quantitative or Stewart approach, which uses the strong ion difference and the total weak acids. This article explores the origins of the current concepts framing the existing methods to analyze acid base balance.
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Acute kidney injury (AKI) is a common and often lethal complication that is also associated with severe morbidity in hospitalized patients. During the last decade, the standardization of AKI diagnostic criteria has helped to facilitate several large-scale investigations of biomarkers of AKI. ⋯ This review summarizes the results of many of these multicenter investigations and discusses the clinical utility and interpretation of several of these new clinical tests. The merits of combining biomarkers of kidney function is also discussed.
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Critical care clinics · Oct 2015
ReviewThrombocytopenia-Associated Multiple Organ Failure and Acute Kidney Injury.
Thrombocytopenia-associated multiple organ failure (TAMOF) is a clinical phenotype that encompasses a spectrum of syndromes associated with disseminated microvascular thromboses, such as the thrombotic microangiopathies thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS) and disseminated intravascular coagulation (DIC). Autopsies findings in TTP, HUS, or DIC reveal specific findings that can differentiate these 3 entities. ⋯ Tissue factor is the major protease that drives the pathology of DIC. Acute kidney injury (AKI) is a common feature in patients with TAMOF.
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Epidemiologic studies applying the acute kidney injury (AKI) classification system have confirmed the increasing incidence of AKI in different settings and its association with adverse outcomes. AKI is now a recognized important risk factor for new-onset chronic kidney disease, determining acceleration in progression to end-stage renal disease, leading to poor quality of life, disability, and long-term costs. AKI has been associated with high mortalities; however, it is likely that a significant number of deaths associated with AKI could be avoided. This article reviews the key aspects of the 0by25 initiative and its application in critically ill patients.