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AcuteKidneyInjury

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Critical Care

Urine soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) has been reported in sepsis diagnosis and prediction of sepsis-associated acute kidney injury (AKI). However, the mechanisms of the role of sTREM-1 for AKI remain unclear. It may be that topical inflammatory response of kidney, not just systemic inflammation, contributes to the elevated secretion of urine sTREM-1 in the process of sepsis-associated AKI. To further evaluate the role of sTREM-1 in this process, a larger-cohort multicenter study and the relevant basic research should be performed to reveal the diagnostic value and mechanism of sTREM-1 during the sepsis-associated AKI process. If successful, then urine sTREM-1 would be a good marker for sepsis and its associated AKI and could contribute to non-invasive diagnosis and monitoring in the clinical setting. Additionally, owing to the complexity of the pathogenesis of sepsis, it is necessary to combine some biomarkers to improve diagnostic performance in the diagnosis of sepsis-associated AKI rather than relying on a single marker.  
ccforum.com
over 4 years ago
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Critical Care

Acute kidney injury (AKI) is a common complication in intensive care unit (ICU) patients and is associated with increased morbidity and mortality. We compared long-term outcome and quality of life (QOL) in ICU patients with AKI treated with renal replacement therapy (RRT) with matched non-AKI-RRT patients.  
ccforum.com
about 4 years ago
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Imaging Case of the Week 165

The following AP thoracolumbar x-ray is from a 65 year old who has presented to the ED with severe thoracic pain. He is noted to have acute renal failure and hypercalcaemia on blood tests. What subtle finding can be seen?   
emergucate.com
about 4 years ago
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Imaging Case of the Week 165 Answer

The thoracic spine x-ray shows destruction of the left pedicle of the T8 vertebra by a lytic process (winking owl sign). In the context of acute renal failure and hypercalcaemia, this is likely to be a myeloma deposit. Myeloma was confirmed on further tests.  
emergucate.com
about 4 years ago
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Critical Care

There is a sex difference in the risk of ischemic acute kidney injury (AKI), and estrogen mediates the protective effect of female sex. We previously demonstrated that preprocedural chronic restoration of physiologic estrogen to ovariectomized female mice ameliorated AKI after cardiac arrest and cardiopulmonary resuscitation (CA/CPR). In the present study, we hypothesized that male mice and aged female mice would benefit from estrogen administration after CA/CPR. We tested the effect of estrogen in a clinically relevant manner by administrating it after CA/CPR.  
ccforum.com
about 4 years ago
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Interventions for renal vasculitis in adults | Cochrane

Renal vasculitis presents as rapidly progressive glomerulonephritis which is a form of kidney disease that causes damage to the small structures (glomeruli) inside the kidneys that help filter waste and fluids from blood to form urine. The disease leads to a rapid loss of kidney function. Standard suppression of the immune system with steroids and cyclophosphamide is recommended. The aim of this review was to evaluate the benefits and harms of any intervention for the treatment of renal vasculitis. Thirty one studies (2217 patients) were identified. Plasma exchange reduces the risk of end-stage kidney disease in patients presenting with severe acute kidney failure. The use of pulse cyclophosphamide results in good remission rates but there was an increased risk of relapse. Azathioprine is effective as maintenance therapy once remission has been achieved. Mycophenolate mofetil is equivalent for remission induction than cyclophosphamide. Mycophenolate mofetil has also been tested in maintenance treatment and was found to result in a higher rate of disease relapse. Initial data on rituximab showed equivalent effectiveness to cyclophosphamide. Methotrexate and leflunomide are useful in maintenance therapy but their relative effectiveness are not clearly defined. Treatment with co-trimoxazole may prevent respiratory infections and relapses but are unlikely to have a major impact on systemic relapses of vasculitis.  
cochrane.org
about 4 years ago
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Fluid Management: Buffered Crystalloid No Benefit vs Saline

Among patients in the ICU receiving crystalloid fluid therapy, use of a buffered crystalloid compared with saline did not reduce the risk for acute kidney injury in a randomized trial.  
medscape.com
about 4 years ago
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Critical Care

To determine whether single nucleotide polymorphisms (SNPs) in FAS and related genes are associated with acute kidney injury (AKI) in patients with acute respiratory distress syndrome (ARDS).  
ccforum.com
about 4 years ago
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Investigating hyperkalaemia in adults

The cause of hyperkalaemia in adults is usually obvious from the patient’s history: the commonest causes are acute kidney injury, chronic kidney disease, and drugs  
feeds.bmj.com
almost 4 years ago
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Investigating hyperkalaemia in adults

The cause of hyperkalaemia in adults is usually obvious from the patient’s history: the commonest causes are acute kidney injury, chronic kidney disease, and drugs  
feeds.bmj.com
almost 4 years ago
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Investigating hyperkalaemia in adults

The cause of hyperkalaemia in adults is usually obvious from the patient’s history: the commonest causes are acute kidney injury, chronic kidney disease, and drugs  
feeds.bmj.com
almost 4 years ago
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Investigating hyperkalaemia in adults

The cause of hyperkalaemia in adults is usually obvious from the patient’s history: the commonest causes are acute kidney injury, chronic kidney disease, and drugs  
feeds.bmj.com
almost 4 years ago
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Critical Care

In a recent article, Balzer et al. [1] reported an unexpected relationship between an initial central venous oxygen saturation (ScvO2) >80 % on ICU admission and increased morbidity and mortality in cardiac surgery patients. Interestingly, as compared with low (<60 %) or normal (60–80 %) ScvO2 levels, values above 80 % were associated with more acute kidney injury (AKI) and a higher hemodialysis need. This goes against common belief that a higher ScvO2 is a prerequisite for more optimal organ, and in particular kidney, protection.  
ccforum.com
almost 4 years ago
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Investigating hyperkalaemia in adults

The cause of hyperkalaemia in adults is usually obvious from the patient’s history: the commonest causes are acute kidney injury, chronic kidney disease, and drugs  
feeds.bmj.com
almost 4 years ago
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Investigating hyperkalaemia in adults

The cause of hyperkalaemia in adults is usually obvious from the patient’s history: the commonest causes are acute kidney injury, chronic kidney disease, and drugs  
feeds.bmj.com
almost 4 years ago
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1

Critical Care

Early and aggressive volume resuscitation is fundamental in the treatment of hemodynamic instability in critically ill patients and improves patient survival. However, one important consequence of fluid administration is the risk of developing fluid overload (FO), which is associated with increased mortality in patients with acute kidney injury (AKI). We evaluated the impact of fluid balance on mortality in intensive care unit (ICU) patients with AKI.  
ccforum.com
almost 4 years ago
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Managing AKI Just Got More Stressful

Do the risks of the furosemide stress test outweigh the value for patients with acute kidney injury?  
medscape.com
almost 4 years ago
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Critical Care

Prevalence of chronic kidney disease (CKD) amongst intensive care unit (ICU) admissions is rising. How mortality and risk of end-stage renal disease (ESRD) differs between those with and without CKD and with acute kidney injury (AKI) is unclear. Determining factors that increase the risk of ESRD is essential to optimise treatment, identify patients requiring nephrological surveillance and for quantification of dialysis provision.  
ccforum.com
almost 4 years ago
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Nitric Oxide Reduces Kidney Injury in Heart-Valve Surgery

Acute kidney injury occurs is nearly one third of patients undergoing heart surgery with prolonged cardiopulmonary bypass, but a new study suggests the administration of nitric oxide might be protective.  
medscape.com
almost 4 years ago