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American Journal of Kidney Diseases :... Mar 2020The intensive care unit (ICU) is a common source of high-acuity nephrology consultations. Although advanced chronic kidney disease is associated with increased ICU... (Review)
Review
The intensive care unit (ICU) is a common source of high-acuity nephrology consultations. Although advanced chronic kidney disease is associated with increased ICU mortality, the prognosis of acute kidney injury (AKI) requiring renal replacement therapy is far worse, with short-term mortality rates that often exceed 50%. As such, it is essential that practicing nephrologists be comfortable caring for critically ill patients. This Core Curriculum article emphasizes the developments of the last decade since the last Core Curriculum installment on this topic in 2009. We focus on some of the most common causes of AKI in the critical care setting and use these AKI causes to delve into specific topics most relevant to critical care nephrology, including acute respiratory distress syndrome, extracorporeal membrane oxygenation, evolving concepts in fluid management, and shock. We conclude by reviewing the basics of palliative care nephrology and dialysis decision making in the ICU.
Topics: Acute Kidney Injury; Critical Care; Curriculum; Global Health; Humans; Incidence; Nephrology; Renal Replacement Therapy
PubMed: 31982214
DOI: 10.1053/j.ajkd.2019.10.010 -
The Ulster Medical Journal May 2021Rhabdomyolysis (RML) is a pathological entity characterized by symptoms of myalgia, weakness and dark urine (which is often not present) resulting in respiratory failure... (Review)
Review
Rhabdomyolysis (RML) is a pathological entity characterized by symptoms of myalgia, weakness and dark urine (which is often not present) resulting in respiratory failure and altered mental status. Laboratory testing for myoglobinuria is pathognomonic but so often not present during the time of testing that serum creatine kinase should always be sent when the diagnosis is suspected. Kidney injury from RML progresses through multiform pathways resulting in acute tubular necrosis. Early treatment (ideally<6 hoursfrom onset) is needed with volume expansion of all non-overloaded patients along with avoidance of nephrotoxins. There is insufficient data to recommend any specific fluid. The mortality rate ranges from 10% to up to 50% with severe AKI, so high index of suspicion and screening should be in care plan of seriously ill patients at risk for RML.
Topics: Acute Kidney Injury; Creatine Kinase; Humans; Mental Disorders; Myoglobinuria; Rhabdomyolysis
PubMed: 34276082
DOI: No ID Found -
Primary Care Dec 2020Acute kidney injury (AKI) is defined as an increase in serum creatinine or a decrease in urine output over hours to days. A thorough history and physical examination can... (Review)
Review
Acute kidney injury (AKI) is defined as an increase in serum creatinine or a decrease in urine output over hours to days. A thorough history and physical examination can help categorize the underlying cause as prerenal, intrinsic renal, or postrenal. Initial evaluation and management of AKI in the community setting includes laboratory work-up, medication adjustment, identification and reversal of underlying cause, and referral to appropriate specialty care. Even one episode of AKI increases the risk of cardiovascular disease, chronic kidney disease, and death. Therefore, early determination of etiology, management, and long-term follow-up of AKI are essential.
Topics: Acute Kidney Injury; Biomarkers; Creatinine; Dose-Response Relationship, Drug; Drug-Related Side Effects and Adverse Reactions; Humans; Pharmaceutical Preparations; Primary Health Care; Referral and Consultation; Severity of Illness Index; Water-Electrolyte Balance
PubMed: 33121629
DOI: 10.1016/j.pop.2020.08.008 -
Nephrology, Dialysis, Transplantation :... Dec 2023Sepsis is a host's deleterious response to infection, which could lead to life-threatening organ dysfunction. Sepsis-associated acute kidney injury (SA-AKI) is the most... (Review)
Review
Sepsis is a host's deleterious response to infection, which could lead to life-threatening organ dysfunction. Sepsis-associated acute kidney injury (SA-AKI) is the most frequent organ dysfunction and is associated with increased morbidity and mortality. Sepsis contributes to ≈50% of all AKI in critically ill adult patients. A growing body of evidence has unveiled key aspects of the clinical risk factors, pathobiology, response to treatment and elements of renal recovery that have advanced our ability to detect, prevent and treat SA-AKI. Despite these advancements, SA-AKI remains a critical clinical condition and a major health burden, and further studies are needed to diminish the short and long-term consequences of SA-AKI. We review the current treatment standards and discuss novel developments in the pathophysiology, diagnosis, outcome prediction and management of SA-AKI.
Topics: Adult; Humans; Multiple Organ Failure; Acute Kidney Injury; Kidney; Prognosis; Sepsis; Critical Illness
PubMed: 37401137
DOI: 10.1093/ndt/gfad142 -
Critical Care Clinics Jul 2022Initial reporting suggested that kidney involvement following COVID-19 infection was uncommon but this is now known not to be the case. Acute kidney injury (AKI) may... (Review)
Review
Initial reporting suggested that kidney involvement following COVID-19 infection was uncommon but this is now known not to be the case. Acute kidney injury (AKI) may arise through several mechanisms and complicate up to a quarter of patients hospitalized with COVID-19 infection being associated with an increased risk for both morbidity and death. Mechanisms of injury include direct kidney damage predominantly through tubular injury, although glomerular injury has been reported; the consequences of the treatment of patients with severe hypoxic respiratory failure; secondary infection; and exposure to nephrotoxic drugs. The mainstay of treatment remains the prevention of worsening kidney damage and in some cases they need for renal replacement therapies (RRT). Although the use of other blood purification techniques has been proposed as potential treatments, results to-date have not been definitive.
Topics: Acute Kidney Injury; COVID-19; Humans; Renal Replacement Therapy; SARS-CoV-2
PubMed: 35667738
DOI: 10.1016/j.ccc.2022.01.002 -
Indian Journal of Pediatrics Aug 2020Pediatric medicine is growing in complexity and an increasing number of children with co-morbidities are exposed to potential renal damage. Initially ill-defined and... (Review)
Review
Pediatric medicine is growing in complexity and an increasing number of children with co-morbidities are exposed to potential renal damage. Initially ill-defined and thought to be mostly a transient phenomenon in children, acute kidney injury (AKI) has now emerged as a complex clinical syndrome independently associated with increased mortality and morbidity, including the development of chronic renal sequelae. Recent advances in molecular nephrology have better elucidated the early phase of AKI, where evidence of renal tissue damage is associated with adverse outcomes even without decrease in glomerular filtration rate, illustrating the flaws of the old paradigm based solely on an insensitive filtration marker, the serum creatinine. Prevention, prompt evaluation and early interventions are of essence to decrease AKI incidence and severity. Emerging data reveal that AKI is commonly encountered in hospitalized children, especially critically ill ones, hence the importance for all clinicians to be able to identify high risk patients, recognize AKI early and be comfortable with the initial medical management. In recent years, significant advances have been made in AKI definition and prediction, allowing early preventive measures in high risk children that are now proven to reduce AKI incidence. This review covers recent advances in the diagnosis, risk stratification, prevention and management of AKI in children.
Topics: Acute Kidney Injury; Biomarkers; Child; Creatinine; Critical Illness; Glomerular Filtration Rate; Humans; Kidney Function Tests
PubMed: 31713215
DOI: 10.1007/s12098-019-03096-y -
Clinical Journal of the American... Jul 2019Acute pancreatitis is a common disorder of the pancreas. It is the most frequent gastrointestinal cause for hospitalization and one of the leading causes of in-hospital... (Review)
Review
Acute pancreatitis is a common disorder of the pancreas. It is the most frequent gastrointestinal cause for hospitalization and one of the leading causes of in-hospital deaths. Its severity ranges from mild self-limited disease to severe acute necrotizing pancreatitis characterized by systemic complications and multiorgan failure. Severe acute pancreatitis develops in about 20% of patients with acute pancreatitis and may be associated with multiorgan failure (respiratory, cardiovascular, and kidney). AKI is a frequent complication of severe acute pancreatitis and develops late in the course of the disease, usually after the failure of other organs. It carries a very poor prognosis, particularly if kidney replacement therapy is required, with mortality rates exceeding 75%. The exact pathophysiology of AKI in acute pancreatitis remains unclear but appears to result from initial volume depletion followed by complex vascular and humoral factors. Here, we provide an overview of the epidemiology, pathogenesis, causes, and management of AKI in patients with severe acute pancreatitis.
Topics: Acute Kidney Injury; Fluid Therapy; Humans; Pancreatitis; Renal Replacement Therapy
PubMed: 31118209
DOI: 10.2215/CJN.13191118 -
The New England Journal of Medicine May 2020
Review
Topics: Acute Kidney Injury; Acute-On-Chronic Liver Failure; Anti-Bacterial Agents; Humans; Liver; Liver Cirrhosis; Liver Transplantation
PubMed: 32459924
DOI: 10.1056/NEJMra1914900 -
Kidney International Jun 2023Acute kidney injury (AKI) occurs in about half of critically ill patients and is associated with high in-hospital mortality, increased long-term mortality postdischarge,... (Review)
Review
Acute kidney injury (AKI) occurs in about half of critically ill patients and is associated with high in-hospital mortality, increased long-term mortality postdischarge, and subsequent progression to chronic kidney disease. Numerous clinical studies have shown that AKI is often complicated by dysfunction of distant organs, which is a cause of the high mortality incidence associated with AKI. Experimental studies have elucidated many mechanisms of AKI-induced distant organ injury, which include inflammatory cytokines, oxidative stress, and immune responses. This review provides an update on evidence of organ crosstalk and potential therapeutics for AKI-induced organ injuries, and presents the new concept of a systemic organ network that balances homeostasis and involves multi-organ crosstalk beyond that of the kidney with a single distant organ.
Topics: Humans; Multiple Organ Failure; Aftercare; Patient Discharge; Acute Kidney Injury; Kidney; Critical Illness
PubMed: 37030663
DOI: 10.1016/j.kint.2023.03.025 -
Clinical Journal of the American... Feb 2020Hematopoietic stem cell transplantation is a life-saving therapy for many patients with cancer, as well as patients with some nonmalignant hematologic disorders, such as... (Review)
Review
Hematopoietic stem cell transplantation is a life-saving therapy for many patients with cancer, as well as patients with some nonmalignant hematologic disorders, such as aplastic anemia, sickle cell disease, and certain congenital immune deficiencies. Kidney injury directly associated with stem cell transplantation includes a wide range of structural and functional abnormalities, which may be vascular (hypertension, thrombotic microangiopathy), glomerular (albuminuria, nephrotic glomerulopathies), and/or tubulointerstitial. AKI occurs commonly after stem cell transplant, affecting 10%-73% of patients. The cause is often multifactorial and can include sepsis, nephrotoxic medications, marrow infusion syndrome, hepatic sinusoidal obstruction syndrome, thrombotic microangiopathy, infections, and graft versus host disease. The risk of post-transplant kidney injury varies depending on patient characteristics, type of transplant (allogeneic versus autologous), and choice of chemotherapeutic conditioning regimen (myeloablative versus nonmyeloablative). Importantly, AKI is associated with substantial morbidity, including the need for KRT in approximately 5% of patients and the development of CKD in up to 60% of transplant recipients. AKI has been associated universally with higher all-cause and nonrelapse mortality regardless of transplant type, and studies have consistently shown extremely high (>80%) mortality rates in those patients requiring acute dialysis. Accordingly, prevention, early recognition, and prompt treatment of kidney injury are essential to improving kidney and patient outcomes after hematopoietic stem cell transplantation, and for realizing the full potential of this therapy.
Topics: Acute Kidney Injury; Early Diagnosis; Hematopoietic Stem Cell Transplantation; Humans; Incidence; Renal Insufficiency, Chronic; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 31836598
DOI: 10.2215/CJN.08580719