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Fluid Management in AKI

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https://www.readbyqxmd.com/read/29285109/acute-kidney-injury-in-cancer-patients-and-impedance-cardiography-assisted-renal-replacement-therapy-experience-from-the-onconephrology-unit-of-a-chinese-tertiary-hospital
#1
Tao Wang, Yan Zhang, Qingxia Li, Shumin Jia, Changjin Shi, Kai Niu, Bing Liu
Acute kidney injury (AKI) in cancer patients may disrupt anticarcinogenic treatment and greatly increase associated mortality rates. The present study reported on the management of cancer patients with AKI and, from the nephrologic viewpoint, on the significance of fine volume control during the continuous renal replacement therapy (CRRT). The records of 117 cancer patients with AKI treated over three years were reviewed and their data were compared with those of 120 healthy controls. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria with serum creatinine levels determined on initial admission and for the diagnosis of AKI...
December 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/29274596/pragmatic-studies-for-acute-kidney-injury-consensus-report-of-the-acute-disease-quality-initiative-adqi-19-workgroup
#2
Zhiyong Peng, Kaijiang Yu, Marlies Ostermann, XiuMing Xi, Raymond Hsu, Jean-Louis Vincent, John R Prowle, Bin Du, Martin Gallagher, Changsong Wang, Raghavan Murugan, Haibo Qiu, Thomas Rimmelé, Jianguo Li, Lui G Forni, Kianoush Kashani, Claudio Ronco, John A Kellum
PURPOSE: Acute kidney injury (AKI) has become a major medical and financial burden in China along with the rest of the world. There have been considerable advances in the understanding of the epidemiology and pathogenesis of AKI. However, there is no consensus regarding the optimal care for patients. The Acute Disease Quality Initiative (ADQI) 19 meeting focused on identifying and designing relevant and achievable AKI-related studies in China. MATERIALS & METHODS: The working group developed a list of preliminary questions and objectives and performed analysis of the existing literature...
December 12, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29249231/hemoglobinuric-acute-kidney-injury-in-a-patient-with-a-kinked-prosthetic-aortic-graft%C3%A2
#3
Hema V Sheelvanth, Khaleel A Sayeed, William A Whittier
Acute kidney injury (AKI) due to intravascular hemolysis has been well described in paroxysmal nocturnal hemoglobinuria (PNH) and in cardiac valvular dysfunction. However, reported cases of hemoglobinuric AKI from prosthetic aortic grafts are sparse. We present a case of microangiopathic hemolytic anemia and hemoglobinuric AKI presenting 9 days after repair of an ascending aortic dissection with a prosthetic graft. After an unremarkable recovery following the initial procedure, the patient presented on postoperative day 9 with dyspnea, fatigue, and cola-colored urine...
December 18, 2017: Clinical Nephrology
https://www.readbyqxmd.com/read/29248587/enhanced-case-management-can-be-delivered-for-patients-with-evd-in-africa-experience-from-a-uk-military-ebola-treatment-centre-in-sierra-leone
#4
S J Dickson, K A Clay, M Adam, C Ardley, M S Bailey, D S Burns, A T Cox, D G Craig, M Espina, G Fitchett, J Grindrod, D E Hinsley, S Horne, E Hutley, A M Johnston, R L C Kao, L E Lamb, S Lewis, D Marion, A J Moore, T C Nicholson-Roberts, A Phillips, J Praught, P S Rees, I Schoonbaert, T Trinick, D R Wilson, A J Simpson, D Wang, M K O'Shea, T E Fletcher
BACKGROUND: Limited data exist describing supportive care management, laboratory abnormalities and outcomes in patients with EVD (Ebola virus disease) in West Africa. We report data which constitute the first description of the provision of enhanced EVD case management protocols in a West African setting. METHODS: Demographic, clinical and laboratory data were collected by retrospective review of clinical and laboratory records of patients with confirmed EVD admitted between 5 November 2014 and 30 June 2015...
December 14, 2017: Journal of Infection
https://www.readbyqxmd.com/read/29248148/acute-kidney-injury-in-pediatric-patients
#5
REVIEW
David M Kwiatkowski, Scott M Sutherland
Acute kidney injury (AKI) is highly prevalent among hospitalized children, especially those who are critically ill. The incorporation of pediatric elements into consensus definitions has led to a greater understanding of pediatric AKI epidemiology, risk factors, and outcomes. The best available data suggest that AKI occurs in 5% and 27% of non-critically ill and critically ill children, respectively. Additionally, AKI and fluid overload are independently associated with worse outcomes including mortality. Currently, the diagnosis of AKI relies upon urine output and creatinine measurements, both of which pose unique problems in children...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29248144/renal-replacement-therapy-for-aki-when-how-much-when-to-stop
#6
REVIEW
Stefano Romagnoli, William R Clark, Zaccaria Ricci, Claudio Ronco
Severe acute kidney injury (AKI) requiring renal replacement therapy (RRT) is a serious clinical disorder in the intensive care unit (ICU), occurring in a significant proportion of critically ill patients. However, many questions remain about the optimal administration of RRT with regard to several important considerations, including treatment dose, timing of treatment initiation and cessation, therapy mode, type of anticoagulation, and management of fluid overload. While Level 1 evidence exists for RRT dosing in AKI, all the studies contributing to this evidence base employed fixed-dose regimens throughout a patient's continuous RRT (CRRT) course, without regard for the possibility of individualizing treatment dose according to the clinical status of a given patient at a specific time...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29220757/association-between-postoperative-fluid-balance-and-acute-kidney-injury-in-patients-after-cardiac-surgery-a-retrospective-cohort-study
#7
Yanfei Shen, Weimin Zhang, Xuping Cheng, Manzhen Ying
PURPOSE: The present study aims to explore appropriate postoperative fluid management in patients after cardiac surgery. MATERIALS AND METHODS: Data were extracted from an online database. Associations between fluid balance (FB), fluid intake and mortality were investigated. RESULTS: Compared to zero FB (level 3), more negative FB (level 1, odds ratio (OR): 0.938, 95% CI: 0.631-1.394; level 2, OR: 0.921, 95% CI: 0.709-1.196) could not further decrease AKI incidence while positive FB was associated with higher AKI incidence (level 4, OR: 1...
December 1, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29128923/fluid-overload-independent-of-acute-kidney-injury-predicts-poor-outcomes-in-neonates-following-congenital-heart-surgery
#8
Kenneth E Mah, Shiying Hao, Scott M Sutherland, David M Kwiatkowski, David M Axelrod, Christopher S Almond, Catherine D Krawczeski, Andrew Y Shin
BACKGROUND: Fluid overload (FO) is common after neonatal congenital heart surgery and may contribute to mortality and morbidity. It is unclear if the effects of FO are independent of acute kidney injury (AKI). METHODS: This was a retrospective cohort study which examined neonates (age < 30 days) who underwent cardiopulmonary bypass in a university-affiliated children's hospital between 20 October 2010 and 31 December 2012. Demographic information, risk adjustment for congenital heart surgery score, surgery type, cardiopulmonary bypass time, cross-clamp time, and vasoactive inotrope score were recorded...
November 11, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/29111542/a-call-to-action-to-develop-integrated-curricula-in-cardiorenal-medicine
#9
Claudio Ronco, Federico Ronco, Peter A McCullough
With the adoption of the new definition and classification of cardiorenal syndrome (CRS) and its relevant subtypes, much attention has been placed on elucidating the mechanisms of heart and kidney interactions. The pathophysiologic pathways are of great interest by which acute heart failure may result in acute kidney injury (AKI; type 1), chronic heart failure accelerates the progression of chronic kidney disease (CKD; type 2), AKI provokes cardiac events (type 3), and CKD increases the risk and severity of cardiovascular disease (type 4)...
2017: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29065398/a-call-to-action-to-develop-integrated-curricula-in-cardiorenal-medicine
#10
Claudio Ronco, Federico Ronco, Peter A McCullough
With the adoption of the new definition and classification of cardiorenal syndrome (CRS) and its relevant subtypes, much attention has been placed on elucidating the mechanisms of heart and kidney interactions. Of great interest are the pathophysiological pathways by which acute heart failure may result in acute kidney injury (AKI; type 1), chronic heart failure accelerating the progression of chronic kidney disease (CKD; type 2), AKI provoking cardiac events (type 3), and CKD increasing the risk and severity of cardiovascular disease (type 4)...
October 25, 2017: Blood Purification
https://www.readbyqxmd.com/read/29057120/ivc-measurements-in-critically-ill-patients-with-acute-renal-failure
#11
Rami Jambeih, Jean I Keddissi, Houssein A Youness
OBJECTIVE: To determine whether the inferior vena cava (IVC) measurement by bedside ultrasound (US-IVC) predicts improvement in renal function in patients with acute kidney injury (AKI). DESIGN: Prospective observational study. SETTING: Medical intensive care unit. PATIENTS: 33 patients with AKI were included. INTERVENTION: US-IVC was done on admission. The patients' management was done by the primary teams, who were unaware of the US-IVC findings...
2017: Critical Care Research and Practice
https://www.readbyqxmd.com/read/28932401/practical-approach-to-detection-and-management-of-acute-kidney-injury-in-critically-ill-patient
#12
REVIEW
Vahid Mohsenin
BACKGROUND: Acute kidney injury (AKI) is a common complication in critically ill patients and is associated with high morbidity and mortality. This paper provides a critical review of the etiologies of AKI and a systematic approach toward its diagnosis and management with emphasis on fluid volume assessment and the use of urine biochemical profile and microscopy in identifying the nature and the site of kidney injury. MATERIALS AND METHODS: The search of PubMed and selection of papers had employed observational designs or randomized control trials relevant to AKI...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28865484/renal-ultrasound-provides-low-utility-in-evaluating-cardiac-surgery-associated-acute-kidney-injury
#13
Allen Young, Todd Crawford, Alejandro Suarez Pierre, J Trent Magruder, Charles Fraser, John Conte, Glenn Whitman, Christopher Sciortino
BACKGROUND: Renal ultrasonography is part of the algorithm in assessing acute kidney injury (AKI). The purpose of this study was to assess the clinical utility of renal US in postoperative cardiac patients who develop AKI. METHODS: We conducted a retrospective study of 90 postoperative cardiac surgery patients at a single institution from 1/19/2010 to 3/19/2016 who underwent renal US for AKI. We reviewed provider documentation to determine whether renal US changed management...
September 2, 2017: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28820797/postoperative-renal-dysfunction-after-noncardiac-surgery
#14
Suvi T Vaara, Rinaldo Bellomo
PURPOSE OF REVIEW: The narrative review aims to discuss recent results and important knowledge gaps regarding acute kidney injury (AKI) in postoperative patients undergone major noncardiac surgery. RECENT FINDINGS: Postoperative AKI affects approximately one-fifth of patients after major surgery, but the incidence varies according to the type of surgery. Preexisting chronic kidney disease is a major risk factor for postoperative AKI. It carries a substantial risk for postoperative adverse outcomes, as well as long-term mortality and morbidity...
October 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28699323/intra-procedural-continuous-dialysis-to-facilitate-interventional-catheterization-in-pediatric-patients-with-severe-renal-failure
#15
Angeline D Opina, Athar M Qureshi, Eileen Brewer, Ewa Elenberg, Sarah Swartz, Mini Michael, Henri Justino
BACKGROUND: Interventional catheterization procedures may be needed for patients with severe renal failure who are dependent on dialysis. To avoid the risk of fluid overload and electrolyte derangement during complex procedures in this oliguric/anuric patient population, we performed intra-procedural dialysis, either continuous renal replacement therapy (CRRT) or continous cycling peritoneal dialysis (CCPD). METHODS: We performed a retrospective review of a cohort of pediatric patients, ages 0-18 years, with dialysis-dependent renal failure who received CRRT or CCPD during catheterization procedures from January 2013 to March 2016...
July 12, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28620570/perforated-bladder-as-a-cause-of-abdominal-ascites-in-a-patient-presenting-with-acute-onset-abdominal-pain
#16
Raj Shah, Madhuri Ramakrishnan, Beenish Ahmed, Khalil Abuamr, Osama Yousef
Bladder perforation, especially when atraumatic, is a rare cause of ascites and is often difficult to differentiate from other causes of abdominal pain and ascites in the acute setting.  A 43-year-old Caucasian woman with a history of multiple sclerosis presented with acute abdominal pain. A computed tomography (CT) scan of her abdomen and pelvis without contrast revealed ascites, acute kidney injury (AKI) was noted on laboratory workup, and very little urine was drained by Foley catheter. Over the next several days, the patient's clinical condition deteriorated with no definitive diagnosis...
May 11, 2017: Curēus
https://www.readbyqxmd.com/read/28616213/postoperative-goal-directed-therapy-and-development-of-acute-kidney-injury-following-major-elective-noncardiac-surgery-post-hoc-analysis-of-pom-o-randomized-controlled-trial
#17
Amour Patel, John R Prowle, Gareth L Ackland
Background: The role of goal-directed therapy (GDT) in preventing creatinine rise following noncardiac surgery is unclear. We performed a post-hoc analysis of a randomized controlled trial to assess the relationship between postoperative optimization of oxygen delivery and development of acute kidney injury (AKI)/creatinine rise following noncardiac surgery. Methods: Patients were randomly assigned immediately postoperatively to receive either fluid and/or dobutamine therapy to maintain/restore their preoperative oxygen delivery, or protocolized standard care (oxygen delivery only recorded)...
June 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/28616210/acute-kidney-injury-an-overview-of-diagnostic-methods-and-clinical-management
#18
Daniel Hertzberg, Linda Rydén, John W Pickering, Ulrik Sartipy, Martin J Holzmann
Acute kidney injury (AKI) is a common condition in multiple clinical settings. Patients with AKI are at an increased risk of death, over both the short and long term, and of accelerated renal impairment. As the condition has become more recognized and definitions more unified, there has been a rapid increase in studies examining AKI across many different clinical settings. This review focuses on the classification, diagnostic methods and clinical management that are available, or promising, for patients with AKI...
June 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/28580076/postoperative-acute-kidney-injury
#19
REVIEW
Jung Tak Park
Acute kidney injury (AKI) after cardiac surgery is a common and serious complication. Several definitions of AKI have been proposed recently, and include both increases in serum creatinine levels and decreases in urine output as diagnostic criteria. The pathophysiology of postoperative AKI is complex and involves both ischemic injury and systemic inflammation. Identifying risk factors, such as old age, underlying diabetes, heart failure, and obesity, may aid in the application of preventative methods for postoperative AKI...
June 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/28561005/management-of-patients-at-risk-of-acute-kidney-injury
#20
REVIEW
Jill Vanmassenhove, Jan Kielstein, Achim Jörres, Wim Van Biesen
Acute kidney injury (AKI) is a multifaceted syndrome that occurs in different settings. The course of AKI can be variable, from single hit and complete recovery, to multiple hits resulting in end-stage renal disease. No interventions to improve outcomes of established AKI have yet been developed, so prevention and early diagnosis are key. Awareness campaigns and education for health-care professionals on diagnosis and management of AKI-with attention to avoidance of volume depletion, hypotension, and nephrotoxic interventions-coupled with electronic early warning systems where available can improve outcomes...
May 27, 2017: Lancet
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