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Anaesthesia Jul 2023Kidney disease, both acute and chronic, is commonly encountered on the intensive care unit. Due to the role the kidneys play in whole body homeostasis, it follows that... (Review)
Review
Kidney disease, both acute and chronic, is commonly encountered on the intensive care unit. Due to the role the kidneys play in whole body homeostasis, it follows that their dysfunction has wide-ranging implications and can affect prescribing and therapeutic management. This narrative review discusses the pathophysiology of acute kidney injury and chronic kidney disease, and how this relates to critically unwell patients. We cover several aspects of the management of renal dysfunction on the critical care unit, exploring some of the recurrent themes within the literature, including type and timing of kidney replacement therapy, management of acute kidney injury, as well as discussing how novel biomarkers for acute kidney injury may help to identify patients suffering from acute kidney injury as well as risk stratifying these patients. We discuss how early involvement of specialist nephrology services can improve outcomes in patients with kidney disease as well as offer valuable diagnostic and specialist management advice, particularly for patients with established end stage kidney disease and patients who are already known to nephrology services. We also explore some of the ongoing research questions that need to be answered within this arena.
Topics: Humans; Nephrology; Intensive Care Units; Renal Insufficiency, Chronic; Kidney Failure, Chronic; Renal Replacement Therapy; Acute Kidney Injury; Critical Illness
PubMed: 36632667
DOI: 10.1111/anae.15964 -
Current Opinion in Cardiology May 2016The purpose of this review is to describe the effects of mechanical circulatory support (MCS) on changes in kidney function and their relationship with mortality, with... (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to describe the effects of mechanical circulatory support (MCS) on changes in kidney function and their relationship with mortality, with an additional focus on the evaluation and management of both preimplant and post-MCS renal dysfunction.
RECENT FINDINGS
Renal dysfunction is highly prevalent in patients referred for MCS and is associated with significantly increased mortality and postoperative acute kidney injury. Most patients, including those with renal dysfunction, experience marked early improvement in renal function with MCS, likely secondary to correction of the cardiogenic shock, volume overload, and neurohormonal activation characteristic of advanced heart failure. Currently, there are no diagnostic tests to definitively distinguish reversible forms of renal dysfunction likely to improve with MCS from irreversible renal dysfunction. Furthermore, the characteristic improvements in renal function observed in the early months of MCS are often transient, with subsequent recurrence of renal dysfunction with longer durations of support. Venous congestion, right ventricular dysfunction, and reduced pulsatility are potential mechanisms involved in resurgence of renal dysfunction following MCS.
SUMMARY
With the exponential growth of MCS, research endeavors to both improve understanding of the mechanisms behind observed changes in renal function and elucidate the device-related effects on the kidney are imperative.
Topics: Assisted Circulation; Heart Failure; Humans; Patient Selection; Prognosis; Renal Dialysis; Renal Insufficiency
PubMed: 27022890
DOI: 10.1097/HCO.0000000000000278 -
Seminars in Thoracic and Cardiovascular... 2021
Topics: Cardiac Surgical Procedures; Humans; Renal Insufficiency; Treatment Outcome
PubMed: 33600973
DOI: 10.1053/j.semtcvs.2021.01.021 -
Kidney International. Supplement May 2002In recent years several multicentric prospective studies have demonstrated the efficacy of some therapeutic measures to slow the progression of renal diseases.... (Review)
Review
In recent years several multicentric prospective studies have demonstrated the efficacy of some therapeutic measures to slow the progression of renal diseases. Inhibition of renin-angiotensin system (RAS) both by ACE inhibitors (ACEI) and angiotensin II receptor antagonists (ARA) is probably the strongest therapeutic alternative: The antiproteinuric effect of these drugs is an excellent surrogate marker and a predictor of the beneficial influences on the progression of renal failure. The type of renal disease, an inadequate control of blood pressure, and the presence of obesity may counteract the beneficial influences of RAS inhibition, whereas early treatment of all patients with significant proteinuria before the appearance of renal insufficiency and combined therapy with an ACEI and an ARA may augment it. Dietary protein restriction is a classic treatment of chronic renal insufficiency whose effectiveness has been validated by multicentric studies. However, a poor compliance of the patient and the risk of malnutrition with very strict protein restriction could limit the benefits of this treatment. Treatment of hyperlipidemia, prevention of obesity, avoidance of smoking, and regular physical exercise are interventions whose therapeutic potential is progressively recognized, particularly in type 2 diabetic nephropathy. Early correction of anemia may contribute to the slowing of renal disease progression. Although further studies are required, the accumulated evidence and the likelihood of additive beneficial effect of these therapeutic measures advise their combined implementation in patients with chronic renal diseases.
Topics: Disease Progression; Humans; Hyperlipidemias; Proteinuria; Renal Insufficiency; Renin-Angiotensin System; Risk Factors; Socioeconomic Factors; Time Factors
PubMed: 11982807
DOI: 10.1046/j.1523-1755.61.s80.5.x -
Nihon Rinsho. Japanese Journal of... Mar 1995Renal failure is a common complication of multiple myeloma, because the kidney is a major target organ for the deposition of paraproteins such as Bence Jones protein... (Review)
Review
Renal failure is a common complication of multiple myeloma, because the kidney is a major target organ for the deposition of paraproteins such as Bence Jones protein (BJP), light chain fragment of monoclonal immunoglobulins, secreted by plasmacytoma. There are three forms of renal involvements related to multiple myeloma. The most common form is cast nephropathy ("myeloma kidney") due to precipitation of BJP combined with Tamm-Horsfall protein in the distal nephron. Other two forms are amyloid nephropathy and light chain deposition disease (LCDD). Renal failure is usually arising from myeloma kidney and is exacerbated by many other factors, for example, concurrently imposed chemical agents. In this manuscript, the mechanism of renal failure mainly due to myeloma kidney and its managements are mainly described.
Topics: Humans; Multiple Myeloma; Renal Insufficiency
PubMed: 7699909
DOI: No ID Found -
Saudi Journal of Kidney Diseases and... 2017
Review
Topics: Arbovirus Infections; Arboviruses; Host-Pathogen Interactions; Humans; Kidney; Prognosis; Renal Insufficiency; Risk Factors
PubMed: 28937090
DOI: 10.4103/1319-2442.215124 -
Journal of the American Society of... Jan 2008It remains unclear whether mild renal dysfunction is associated with adverse cardiovascular outcome. We investigated whether estimated glomerular filtration rate (eGFR)...
It remains unclear whether mild renal dysfunction is associated with adverse cardiovascular outcome. We investigated whether estimated glomerular filtration rate (eGFR) was associated with mortality and cardiac death among 6447 patients with known or suspected coronary artery disease over a mean follow-up of 7 yr. Cumulative 5- and 10-yr survival rates decreased in a graded fashion from 88% and 70%, respectively, for those with normal renal function to 43% and 33% for those with eGFR <30 ml/min. Compared with patients with normal renal function, the multivariable adjusted hazard ratios for all-cause mortality among patients with mild, moderate, and severe renal impairment were 1.33 (95% confidence interval [CI], 1.21-1.48), 1.67 (95% CI, 1.44-1.93), and 3.38 (95% CI, 2.73-4.19), respectively. Similar relationships between cardiac death and decreasing renal function were found. In conclusion, renal function is a graded and independent predictor of long-term mortality in patients with known or suspected coronary artery disease. Intense treatment and close surveillance of these patients is encouraged.
Topics: Adult; Aged; Coronary Disease; Female; Glomerular Filtration Rate; Humans; Incidence; Male; Middle Aged; Renal Insufficiency; Survival Rate
PubMed: 18178803
DOI: 10.1681/ASN.2006101112 -
Anesthesiology Clinics Mar 2010Anesthesiologists often care for patients with renal insufficiency or renal failure. These patients may present to the operating room for a minor procedure such as an... (Review)
Review
Anesthesiologists often care for patients with renal insufficiency or renal failure. These patients may present to the operating room for a minor procedure such as an inguinal hernia repair or an arteriovenous fistula/graft. Alternatively, they may present for major abdominal operations or coronary artery bypass grafting. Critically ill patients presenting to the operating room may have acute kidney injury. It is imperative that the anesthesiologist understands the ramifications of renal failure and adjusts the anesthetic plan accordingly. Hemodynamic monitoring and fluid management can be challenging in this patient population. Various metabolic abnormalities can ensue that the anesthesiologist must be able to manage in the acute setting of the operating room.
Topics: Acute Kidney Injury; Anesthesia; General Surgery; Humans; Kidney; Kidney Function Tests; Renal Insufficiency; Renal Replacement Therapy
PubMed: 20400039
DOI: 10.1016/j.anclin.2010.01.006 -
The Canadian Journal of Urology Jun 2009
Topics: Diagnosis, Differential; Foreign Bodies; Humans; Male; Middle Aged; Renal Insufficiency; Self-Injurious Behavior
PubMed: 19497186
DOI: No ID Found -
JAMA Feb 2024
Topics: Humans; Osteoporosis; Renal Dialysis; Renal Insufficiency
PubMed: 38241040
DOI: 10.1001/jama.2023.24072