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By Venkatesh Ariyamuthu Transplant Nephrologist at UT Southwestern Medical Center
Emilee Wilhelm-Leen, Maria E Montez-Rath, Glenn Chertow
Estimates of the incidence of radiocontrast-associated nephropathy vary widely and suffer from misclassification of the cause of AKI and confounding. Using the Nationwide Inpatient Sample, we created multiple estimates of the risk of radiocontrast-associated nephropathy among adult patients hospitalized in the United States in 2009. First, we stratified patients according to the presence or absence of 12 relatively common diagnoses associated with AKI and evaluated the rate of AKI between strata. Next, we created a logistic regression model, controlling for comorbidity and acuity of illness, to estimate the risk of AKI associated with radiocontrast administration within each stratum...
September 29, 2016: Journal of the American Society of Nephrology: JASN
P Marik, R Bellomo
Aggressive fluid resuscitation to achieve a central venous pressure (CVP) greater than 8 mm Hg has been promoted as the standard of care, in the management of patients with severe sepsis and septic shock. However recent clinical trials have demonstrated that this approach does not improve the outcome of patients with severe sepsis and septic shock. Pathophysiologically, sepsis is characterized by vasoplegia with loss of arterial tone, venodilation with sequestration of blood in the unstressed blood compartment and changes in ventricular function with reduced compliance and reduced preload responsiveness...
March 2016: British Journal of Anaesthesia
Peter A McCullough, James P Choi, Georges A Feghali, Jeffrey M Schussler, Robert M Stoler, Ravi C Vallabahn, Ankit Mehta
Coronary angiography and percutaneous intervention rely on the use of iodinated intravascular contrast for vessel and chamber imaging. Despite advancements in imaging and interventional techniques, iodinated contrast continues to pose a risk of contrast-induced acute kidney injury (CI-AKI) for a subgroup of patients at risk for this complication. There has been a consistent and graded signal of risk for associated outcomes including need for renal replacement therapy, rehospitalization, and death, according to the incidence and severity of CI-AKI...
September 27, 2016: Journal of the American College of Cardiology
David E Leaf, Sushrut S Waikar
Acute kidney injury (AKI) is an increasingly common and feared complication in hospitalized patients. The selection of appropriate primary and secondary end points is critical to the design and eventual success of clinical trials aimed at preventing and treating AKI. In this article, we provide an overview of AKI definitions and suggestions on the rational selection of end points for clinical trials in various settings, including the prevention of contrast-induced AKI, prevention of cardiac surgery-associated AKI, treatment of established AKI, and treatment of dialysis-requiring AKI...
September 3, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Erin Frazee, Kianoush Kashani
BACKGROUND: Intravenous fluids (IVF) are frequently utilized to restore intravascular volume in patients with distributive and hypovolemic shock. Although the benefits of the appropriate use of fluids in intensive care units (ICUs) and hospitals are well described, there is growing knowledge regarding the potential risks of volume overload and its impact on organ failure and mortality. To avoid volume overload and its associated complications, strategies to identify fluid responsiveness are developed and utilized more often among ICU patients...
June 2016: Kidney Diseases
Rolando Claure-Del Granado, Ravindra L Mehta
BACKGROUND: Fluid overload is frequently found in acute kidney injury patients in critical care units. Recent studies have shown the relationship of fluid overload with adverse outcomes; hence, manage and optimization of fluid balance becomes a central component of the management of critically ill patients. DISCUSSION: In critically ill patients, in order to restore cardiac output, systemic blood pressure and renal perfusion an adequate fluid resuscitation is essential...
August 2, 2016: BMC Nephrology
Sumeet Reddy, Laurence Weinberg, Paul Young
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency medicine 2016. Other selected articles can be found online at Further information about the Annual Update in Intensive Care and Emergency Medicine is available from
2016: Critical Care: the Official Journal of the Critical Care Forum
Etienne Macedo, Ravindra L Mehta
No abstract text is available yet for this article.
October 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Jeffrey E Gotts, Michael A Matthay
Sepsis, severe sepsis, and septic shock represent increasingly severe systemic inflammatory responses to infection. Sepsis is common in the aging population, and it disproportionately affects patients with cancer and underlying immunosuppression. In its most severe form, sepsis causes multiple organ dysfunction that can produce a state of chronic critical illness characterized by severe immune dysfunction and catabolism. Much has been learnt about the pathogenesis of sepsis at the molecular, cell, and intact organ level...
2016: BMJ: British Medical Journal
Matthieu Legrand, Can Ince
Acute kidney injury (AKI) has been associated with an increased risk of death and morbidity in many clinical scenarios. The prevention and treatment of AKI therefore has been advocated as a high-priority research focus. However, nearly all strategies tested in this setting have failed to prevent or cure AKI and fluid loading remains a cornerstone of preventive and curative treatment of AKI. Concerns have been raised, however, regarding both the efficacy and safety of fluid loading to prevent or reverse AKI...
January 2016: Seminars in Nephrology
Ron Wald, Sean M Bagshaw
The optimal time to start renal replacement therapy (RRT) in the setting of acute kidney injury (AKI) is one of the most controversial questions in the field of critical care nephrology. An earlier or pre-emptive approach, whereby RRT is initiated in the absence of a life-threatening complication of AKI, may have a variety of plausible benefits. On the other hand, the widespread adoption of such an approach would consume more resources and would have to be justified by evidence of superior patient outcomes...
January 2016: Seminars in Nephrology
Anupam Agarwal, Zheng Dong, Raymond Harris, Patrick Murray, Samir M Parikh, Mitchell H Rosner, John A Kellum, Claudio Ronco
In this article, we review the current evidence for the cellular and molecular mechanisms of AKI, focusing on epithelial cell pathobiology and related cell-cell interactions, using ischemic AKI as a model. Highlighted are the clinical relevance of cellular and molecular targets that have been investigated in experimental models of ischemic AKI and how such models might be improved to optimize translation into successful clinical trials. In particular, development of more context-specific animal models with greater relevance to human AKI is urgently needed...
May 2016: Journal of the American Society of Nephrology: JASN
Seth A Hollander, Maria E Montez-Rath, David M Axelrod, Catherine D Krawczeski, Lindsay J May, Katsuhide Maeda, David N Rosenthal, Scott M Sutherland
BACKGROUND: Acute kidney injury (AKI) is common in children following surgery for congenital heart disease and has been associated with poor long-term kidney outcomes. Children undergoing heart transplantation may be at increased risk for the development of both AKI and chronic kidney disease (CKD). This study examines AKI rates in children, adolescents, and young adults after heart transplantation and analyzes the relationship between AKI and CKD in this population. STUDY DESIGN: Retrospective cohort study...
August 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Olga Baraldi, Chiara Valentini, Gabriele Donati, Giorgia Comai, Vania Cuna, Irene Capelli, Maria Laura Angelini, Maria Ilaria Moretti, Andrea Angeletti, Fabio Piscaglia, Gaetano La Manna
Acute kidney injury (AKI) is a common complication in patients with end-stage liver disease and advanced cirrhosis regardless of the underlying cause. Hepatorenal syndrome (HRS), a functional form of kidney failure, is one of the many possible causes of AKI. HRS is potentially reversible but involves highly complex pathogenetic mechanisms and equally complex clinical and therapeutic management. Once HRS has developed, it has a very poor prognosis. This review focuses on the diagnostic approach to HRS and discusses the therapeutic protocols currently adopted in clinical practice...
November 6, 2015: World Journal of Nephrology
Kenneth P Chen, Susan Cavender, Joon Lee, Mengling Feng, Roger G Mark, Leo Anthony Celi, Kenneth J Mukamal, John Danziger
BACKGROUND AND OBJECTIVES: Although venous congestion has been linked to renal dysfunction in heart failure, its significance in a broader context has not been investigated. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using an inception cohort of 12,778 critically ill adult patients admitted to an urban tertiary medical center between 2001 and 2008, we examined whether the presence of peripheral edema on admission physical examination was associated with an increased risk of AKI within the first 7 days of critical illness...
April 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Alexandre P Garneau, Julie Riopel, Paul Isenring
No abstract text is available yet for this article.
December 31, 2015: New England Journal of Medicine
Hamid Rabb, Matthew D Griffin, Dianne B McKay, Sundararaman Swaminathan, Peter Pickkers, Mitchell H Rosner, John A Kellum, Claudio Ronco
Inflammation is a complex biologic response that is essential for eliminating microbial pathogens and repairing tissue after injury. AKI associates with intrarenal and systemic inflammation; thus, improved understanding of the cellular and molecular mechanisms underlying the inflammatory response has high potential for identifying effective therapies to prevent or ameliorate AKI. In the past decade, much knowledge has been generated about the fundamental mechanisms of inflammation. Experimental work in small animal models has revealed many details of the inflammatory response that occurs within the kidney after typical causes of AKI, including insights into the molecular signals released by dying cells, the role of pattern recognition receptors, the diverse subtypes of resident and recruited immune cells, and the phased transition from destructive to reparative inflammation...
February 2016: Journal of the American Society of Nephrology: JASN
Benjamin D Humphreys, Vincenzo Cantaluppi, Didier Portilla, Kai Singbartl, Li Yang, Mitchell H Rosner, John A Kellum, Claudio Ronco
AKI remains a highly prevalent disease associated with poor short- and long-term outcomes and high costs. Although significant advances in our understanding of repair after AKI have been made over the last 5 years, this knowledge has not yet been translated into new AKI therapies. A consensus conference held by the Acute Dialysis Quality Initiative was convened in April of 2014 and reviewed new evidence on successful kidney repair to identify the most promising pathways that could be translated into new treatments...
April 2016: Journal of the American Society of Nephrology: JASN
Derek C Angus, Tom van der Poll
New England Journal of Medicine, Volume 369, Issue 9, Page 840-851, August 2013.
August 29, 2013: New England Journal of Medicine
Yun Kuy Oh, Chul Woo Yang, Yong-Lim Kim, Shin-Wook Kang, Cheol Whee Park, Yon Su Kim, Eun Young Lee, Byoung Geun Han, Sang Ho Lee, Su-Hyun Kim, Hajeong Lee, Chun Soo Lim
BACKGROUND: Renal infarction is a rare condition resulting from an acute disruption of renal blood flow, and the cause and outcome of renal infarction are not well established. STUDY DESIGN: Case series. SETTING & PARTICIPANTS: 438 patients with renal infarction in January 1993 to December 2013 at 9 hospitals in Korea were included. Renal infarction was defined by radiologic findings that included single or multiple wedge-shaped parenchymal perfusion defects in the kidney...
February 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
2015-11-10 20:53:13
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