Current opinion in critical care
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The purpose of this review is to describe the most common causes of acute interstitial nephritis (AIN), the diagnostic work-up and the therapeutic management. ⋯ AIN is a common cause of acute kidney injury, and therefore, physicians should suspect this entity especially in patients exposed to multiple medications. While immune-allergic reaction to numerous drugs is the most common cause of AIN, other underlying systemic diseases may also be involved, and therefore, every patient should undergo a complete diagnostic evaluation. Kidney biopsy provides the definitive diagnosis of AIN, and certain histologic features may help to identify the underlying condition. In drug-induced AIN, an early discontinuation of the culprit drug is the mainstay of therapy, and unless a rapid recovery of kidney function is observed, a course of glucocorticoid therapy should be initiated.
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Curr Opin Crit Care · Dec 2019
ReviewCoagulopathy in the surgical patient: trauma-induced and drug-induced coagulopathies.
Coagulopathy is the derangement of hemostasis that in surgical patients may result in excessive bleeding, clotting or no measurable effect. The purpose of this review is to provide an overview of the most current evidence and practical approach to trauma- and drug-induced coagulopathy in surgical patients. ⋯ Despite different understandings of the pathophysiology, trauma- and drug-induced coagulopathies are managed following similar protocols. In most of cases of significant surgical bleeding, timely and protocolized approach to correct the coagulopathy is likely to improve patients' outcome.
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Curr Opin Crit Care · Dec 2019
ReviewAbdominal compartment syndrome and intra-abdominal hypertension.
Abdominal compartment syndrome (ACS) is a severe complication resulting from an acute and sustained increase in intra-abdominal pressure (IAP), causing significant morbidity and mortality. Although prospective double-blinded, randomized trials, and evidence-based analysis are lacking there is new evidence that still demonstrates high morbidity and mortality in critically ill populations because of intra-abdominal hypertension (IAH) in the 21st century. The objective of this review is to alert the health professional about this important diagnosis and to highlight the latest updates proposed by the World Abdominal Compartment Society. ⋯ The present review emphasizes the importance of IAH in daily clinical practice and brings new WSACS updates on monitoring and treatment.
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Curr Opin Crit Care · Dec 2019
ReviewAcute kidney injury in hematopoietic stem cell transplantation.
Acute kidney injury (AKI) in the setting of hematopoietic stem cell transplantation (HSCT) is common in pediatric and adult patients. The incidence ranges from 12 to 66%, and development of AKI in the posttransplant course is independently associated with higher mortality. ⋯ Patients who undergo HSCT have many risk factors for developing AKI, including sepsis, use of nephrotoxic medications, graft versus host disease (GVHD), and veno-occlusive disease (VOD). In addition, engraftment syndrome/cytokine storm, transplant-associated thrombotic microangiopathy (TA-TMA), and less common infections with specific renal manifestations, such as BK and adenovirus nephritis, may lead to kidney injury. There has been significant advancement in the understanding of TA-TMA in particular, especially the role of the complement system in its pathophysiology. The role of early dialysis has been explored in the pediatric population, but not well studied in adult HSCT recipients SUMMARY: This review provides an update on the risk factors, causes, and treatment approaches to HSCT-associated AKI.
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Preoperative nutrition support has been extensively studied; however, data on the timing of postoperative nutrition initiation are scarce. The current review focuses on the importance of early nutritional support in surgical patients and their impact on outcomes. ⋯ Existing studies appear to focus mostly on abdominal and gastrointestinal surgery. Further prospective observational and randomized clinical trials across different surgical populations will aid surgeons to better understand how early feeds in either form can reduce morbidity, quality of life, and increase recovery rates.