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Chantal Loirat, Fadi Fakhouri, Gema Ariceta, Nesrin Besbas, Martin Bitzan, Anna Bjerre, Rosanna Coppo, Francesco Emma, Sally Johnson, Diana Karpman, Daniel Landau, Craig B Langman, Anne-Laure Lapeyraque, Christoph Licht, Carla Nester, Carmine Pecoraro, Magdalena Riedl, Nicole C A J van de Kar, Johan Van de Walle, Marina Vivarelli, Véronique Frémeaux-Bacchi
Atypical hemolytic uremic syndrome (aHUS) emerged during the last decade as a disease largely of complement dysregulation. This advance facilitated the development of novel, rational treatment options targeting terminal complement activation, e.g., using an anti-C5 antibody (eculizumab). We review treatment and patient management issues related to this therapeutic approach. We present consensus clinical practice recommendations generated by HUS International, an international expert group of clinicians and basic scientists with a focused interest in HUS...
January 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Hideki Kato, Masaomi Nangaku, Hiroshi Hataya, Toshihiro Sawai, Akira Ashida, Rika Fujimaru, Yoshihiko Hidaka, Shinya Kaname, Shoichi Maruyama, Takashi Yasuda, Yoko Yoshida, Shuichi Ito, Motoshi Hattori, Yoshitaka Miyakawa, Yoshihiro Fujimura, Hirokazu Okada, Shoji Kagami
Atypical hemolytic uremic syndrome (aHUS) is a rare disease characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. In 2013, we developed diagnostic criteria to enable early diagnosis and timely initiation of appropriate treatment for aHUS. Recent clinical and molecular findings have resulted in several proposed classifications and definitions of thrombotic microangiopathy and aHUS. Based on recent advances in this field and the emerging international consensus to exclude secondary TMAs from the definition of aHUS, we have redefined aHUS and proposed diagnostic algorithms, differential diagnosis, and therapeutic strategies for aHUS...
August 2016: Clinical and Experimental Nephrology
Claudio Ronco, Zaccaria Ricci, Stuart L Goldstein
The application of continuous renal replacement therapy (CRRT) in children, before roller pumps and dialysis monitors were available in the intensive care unit, was realized by continuous arteriovenous hemofiltration. Then hemofiltration was coupled with dialysis in order to increase dialytic dose and system efficiency, and the circuit and filters were specifically modified to optimize patency and session life span. After about 30 years, another revolution is ongoing, in that pediatric acute kidney injury (AKI) and fluid accumulation (for which critically ill newborns and children with multiple-organ dysfunction are greatly at risk) are recognized as independently associated with mortality and identified as primary conditions to prevent and aggressively treat...
August 2015: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Lara de Galasso, Francesco Emma, Stefano Picca, Matteo Di Nardo, Emanuele Rossetti, Isabella Guzzo
BACKGROUND: Mortality among critically ill children requiring continuous renal replacement therapy (CRRT) is high. Several factors have been identified as outcome predictors. Many studies have specifically reported a positive association between the fluid overload at CRRT initiation and the mortality of critically ill pediatric patients. METHODS: This study is a retrospective single-center analysis including all patients admitted to the pediatric intensive care unit (PICU) of our hospital who received CRRT between 2000 and 2012...
April 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Joan Sanchez-de-Toledo, Alba Perez-Ortiz, Laura Gil, Tracy Baust, Marcos Linés-Palazón, Santiago Perez-Hoyos, Ferran Gran, Raul F Abella
Acute kidney injury (AKI) is frequent in the postoperative period of pediatric heart surgery and leads to significant morbidity and mortality. Renal replacement therapies (RRTs) are often used to treat AKI; however, these therapies have also been associated with higher mortality rates. Earlier initiation of RRT might improve outcomes. This study aims to investigate the relationship between the RRT and morbidity and mortality after pediatric heart surgery. We performed a single-center retrospective study of all children undergoing pediatric heart surgery between April 2010 and December 2012 at a tertiary children's hospital...
April 2016: Pediatric Cardiology
Wenmin Yang, Jie Hong, Qiyi Zeng, Jianping Tao, Feiyan Chen, Run Dang, Yufeng Liang, Zhiyuan Wu, Yiyu Yang
The efficacy and therapeutic mechanisms of continuous renal replacement therapy (CRRT) for improvement of oxygenation in acute respiratory distress syndrome (ARDS) remain controversial. These questions were addressed by retrospective analysis of severe ARDS patients admitted to the pediatric intensive care unit of our hospital from 2009 to 2015 who received high-volume continuous veno-venous hemofiltration during mechanical ventilation. There was a significant improvement in partial oxygen pressure/fraction of inspired oxygen (PaO2/FiO2) 24 hours after CRRT onset compared with baseline (median change = 51...
2016: Global Pediatric Health
Dawn M Eding, Lindsey R Jelsma, Caryn J Metz, Vanessa S Steen, Jenifer M Wincek
Continuous renal replacement therapy (CRRT) allows gradual, precise removal of excess fluid and solutes. Special considerations are necessary for children who require CRRT because of their smaller circulating blood volumes and the potential for hemodynamic instability associated with the initiation of CRRT. In critically ill children, the CRRT circuit is often primed with blood rather than saline to prevent excessive hemodilution. Two innovative techniques have been designed to limit repeated exposure to donated blood, reduce hemodynamic instability associated with priming of the circuit with blood, and limit interruptions in CRRT...
February 2011: Critical Care Nurse
Zaccaria Ricci, Stuart L Goldstein
BACKGROUND: Continuous renal replacement therapy (CRRT) and peritoneal dialysis are the preferred forms of dialysis delivery in critically ill children for the treatment of severe acute kidney injury. The epidemiology and the outcome of acute pediatric dialysis will be reviewed. SUMMARY: The prospective pediatric CRRT (pCRRT) registry has provided important epidemiologic information: pCRRT is required in about 5% of patients in pediatric intensive care units, and the mortality rate of these patients is about 60%...
2016: Contributions to Nephrology
Claudio Ronco, Zaccaria Ricci
INTRODUCTION: More than 20 years have passed since the first clinical application of continuous renal replacement therapy (CRRT) in children. In that revolutionary era, before roller pumps and dialysis monitors for intensive care units were readily available, continuous arteriovenous hemofiltration was the most common treatment for critically ill children. MAJOR FINDINGS: Those steps were the basis for current knowledge about modern CRRT. Research on circuit rheology and filter materials allowed for the improvement of materials, and the optimization of patency and session life spans...
June 2015: Intensive Care Medicine
Francesco Garzotto, Monica Zanella, Claudio Ronco
The provision of continuous renal replacement therapies (CRRT) to small children has generally required the adaptation of adult machines and modified operational characteristics. CRRT prescription for younger and smaller children versus adults differs significantly due to problems concerning the extracorporeal blood volume, the need for circuit blood priming, and the adaptation of machines designed for adult-sized patients. Moreover, the provision of renal replacement therapy to infants and neonates presents a unique problem: no more than 10-15% of their blood volume should be removed by the extracorporeal circuit to prevent hypotension and anemia...
2014: Nephron. Clinical Practice
Scott M Sutherland, Stuart L Goldstein, Steven R Alexander
Continuous renal replacement therapy (CRRT), which provides gradual, predictable clearance and fluid removal, is commonly used to manage acute kidney injury (AKI) and fluid overload in critically ill children. The Prospective Pediatric CRRT (ppCRRT) Registry, founded in 2001 and comprising 13 pediatric centers in the United States, represents the largest cohort of children receiving CRRT to date. Data from the ppCRRT has been used to describe pediatric CRRT demographics and epidemiology, improve technical aspects of CRRT provision for children, and identify novel or underappreciated risk factors affecting survival...
November 2014: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Zaccaria Ricci, Francesco Guzzi, Germana Tuccinardi, Stefano Romagnoli
Although universally recognized as a crucial component of renal replacement therapy (RRT), dialytic dose has not been investigated in children with renal failure, differently from the adult population. Consequently, clear indications on the adequacy of continuous RRT in pediatric population is currently missing and wide variations in clinical practice exist worldwide. Fluid balance has been identified as a key factor in affecting outcomes these patients. Nonetheless, the concept and the precise evaluation of the dialytic dose for continuous pediatric RRT seems crucial, especially in light of the small body surface area of neonates and infants that might result into a difficult dose calculation...
April 15, 2016: Minerva Pediatrica
Chang Yin Chionh, Sachin S Soni, Fredric O Finkelstein, Claudio Ronco, Dinna N Cruz
BACKGROUND AND OBJECTIVES: The role of peritoneal dialysis in the management of AKI is not well defined, although it remains frequently used, especially in low-resource settings. A systematic review was performed to describe outcomes in AKI treated with peritoneal dialysis and compare peritoneal dialysis with extracorporeal blood purification, such as continuous or intermittent hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: MEDLINE, CINAHL, and Central Register of Controlled Trials were searched in July of 2012...
October 2013: Clinical Journal of the American Society of Nephrology: CJASN
Norio Hanafusa
BACKGROUND: Continuous renal replacement therapy (CRRT) is performed mainly in patients with acute kidney injury, severe sepsis, or septic shock. Evidence has emerged about the indications for and therapeutic conditions of CRRT. In this review, we focus on the evidence for CRRT to date. SUMMARY: CRRT employs diffusion, convection and adsorption to remove solutes from plasma. Indications can be divided into renal and non-renal indications. Concrete renal indications have not yet been determined, except for life-threatening absolute indications...
2015: Blood Purification
Ravindra L Mehta
Several new methods of renal replacement therapy (RRT) are now available for treating patients in the ICU setting. However, utilization of RRT in the ICU is subject to considerable variation and the need for RRT is associated with worse outcomes. Several factors influence the application of dialysis and reflect the interplay of patient and process of care elements that are dynamic in nature. Despite multiple studies evaluating RRT and its application, there are gaps in our knowledge that must be overcome to improve outcomes...
2015: Critical Care: the Official Journal of the Critical Care Forum
Laurent Bitker, Frédérique Bayle, Hodane Yonis, Florent Gobert, Véronique Leray, Romain Taponnier, Sophie Debord, Alina Stoian-Cividjian, Claude Guérin, Jean-Christophe Richard
BACKGROUND: Hypotension is a frequent complication of intermittent hemodialysis (IHD) performed in intensive care units (ICUs). Passive leg raising (PLR) combined with continuous measurement of cardiac output is highly reliable to identify preload dependence, and may provide new insights into the mechanisms involved in IHD-related hypotension. The aim of this study was to assess prevalence and risk factors of preload dependence-related hypotension during IHD in the ICU. METHODS: A single-center prospective observational study performed on ICU patients undergoing IHD for acute kidney injury and monitored with a PiCCO® device...
2016: Critical Care: the Official Journal of the Critical Care Forum
Kent Doi
Kidney injury, including acute kidney injury (AKI) and chronic kidney disease (CKD), has become very common in critically ill patients treated in ICUs. Many epidemiological studies have revealed significant associations of AKI and CKD with poor outcomes of high mortality and medical costs. Although many basic studies have clarified the possible mechanisms of sepsis and septic AKI, translation of the obtained findings to clinical settings has not been successful to date. No specific drug against human sepsis or AKI is currently available...
2016: Journal of Intensive Care
Stéphane Gaudry, David Hajage, Fréderique Schortgen, Laurent Martin-Lefevre, Bertrand Pons, Eric Boulet, Alexandre Boyer, Guillaume Chevrel, Nicolas Lerolle, Dorothée Carpentier, Nicolas de Prost, Alexandre Lautrette, Anne Bretagnol, Julien Mayaux, Saad Nseir, Bruno Megarbane, Marina Thirion, Jean-Marie Forel, Julien Maizel, Hodane Yonis, Philippe Markowicz, Guillaume Thiery, Florence Tubach, Jean-Damien Ricard, Didier Dreyfuss
BACKGROUND: The timing of renal-replacement therapy in critically ill patients who have acute kidney injury but no potentially life-threatening complication directly related to renal failure is a subject of debate. METHODS: In this multicenter randomized trial, we assigned patients with severe acute kidney injury (Kidney Disease: Improving Global Outcomes [KDIGO] classification, stage 3 [stages range from 1 to 3, with higher stages indicating more severe kidney injury]) who required mechanical ventilation, catecholamine infusion, or both and did not have a potentially life-threatening complication directly related to renal failure to either an early or a delayed strategy of renal-replacement therapy...
July 14, 2016: New England Journal of Medicine
Alexander Zarbock, John A Kellum, Christoph Schmidt, Hugo Van Aken, Carola Wempe, Hermann Pavenstädt, Andreea Boanta, Joachim Gerß, Melanie Meersch
IMPORTANCE: Optimal timing of initiation of renal replacement therapy (RRT) for severe acute kidney injury (AKI) but without life-threatening indications is still unknown. OBJECTIVE: To determine whether early initiation of RRT in patients who are critically ill with AKI reduces 90-day all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS: Single-center randomized clinical trial of 231 critically ill patients with AKI Kidney Disease: Improving Global Outcomes (KDIGO) stage 2 (≥2 times baseline or urinary output <0...
May 24, 2016: JAMA: the Journal of the American Medical Association
Paul D Weyker, Xosé L Pérez, Kathleen D Liu
Acute kidney injury (AKI) is an abrupt decrease in kidney function that takes place over hours to days. Sepsis is the leading cause of AKI and portends a particularly high morbidity and mortality, although the severity may vary from a transient rise in serum creatinine to end-stage renal disease. With regard to acid-base management in septic AKI, caution should be used with hyperchloremic crystalloid solutions, and dialysis is often used in the setting of severe acidosis. In the future, biomarkers may help clinicians identify AKI earlier and allow for potential interventions before the development of severe AKI...
June 2016: Clinics in Chest Medicine
2016-10-23 19:34:48
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