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AcuteKidneyInjury

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11

Incidence and Outcomes in Acute Kidney Injury: A Comprehensive Population-Based Study

Epidemiological studies of acute kidney injury (AKI) and acute-on-chronic renal failure (ACRF) are surprisingly sparse and confounded by differences in definition. Reported incidences vary, with few studies being population-based. Given this and our aging population, the incidence of AKI may be much higher than currently thought. We tested the hypothesis that the incidence is higher by including all patients with AKI (in a geographical population base of 523,390) regardless of whether they required renal replacement therapy irrespective of the hospital setting in which they were treated. We also tested the hypothesis that the Risk, Injury, Failure, Loss, and End-Stage Kidney (RIFLE) classification predicts outcomes. We identified all patients with serum creatinine concentrations ≥150 μmol/L (male) or ≥130μmol/L (female) over a 6-mo period in 2003. Clinical outcomes were obtained from each patient's case records. The incidences of AKI and ACRF were 1811 and 336 per million population, respectively. Median age was 76 yr for AKI and 80.5 yr for ACRF. Sepsis was a precipitating factor in 47% of patients. The RIFLE classification was useful for predicting full recovery of renal function (P < 0.001), renal replacement therapy requirement (P < 0.001), length of hospital stay [excluding those who died during admission (P < 0.001)], and in-hospital mortality (P = 0.035). RIFLE did not predict mortality at 90 d or 6 mo. Thus the incidence of AKI is much higher than previously thought, with implications for service planning and providing information to colleagues about methods to prevent deterioration of renal function. The RIFLE classification is useful for identifying patients at greatest risk of adverse short-term outcomes.  
jasn.asnjournals.org
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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0
13

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
almost 4 years ago
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1
10

Critical Care

Saline-based and hydroxyethyl starch solutions are associated with increased risk of renal dysfunction. In the present study, we tested the hypothesis that balanced solutions and a limited volume of hydroxyethyl starch solution (renal protective fluid management [RPF] strategy) would decrease the incidence of postoperative acute kidney injury (AKI) and improve clinical outcomes in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB).  
ccforum.com
almost 4 years ago
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0
13

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
almost 4 years ago
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0
2

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
almost 4 years ago
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0
1

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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0
1

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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0
0

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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0
0

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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0

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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0
0

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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0
6

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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0
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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1
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Acute kidney injury: prevention, detection and management | Guidance and guidelines | NICE

This clinical guideline offers evidence-based advice on the prevention, detection and management of acute kidney injury up to the point of renal replacement therapy.  
nice.org.uk
almost 4 years ago
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0
10

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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1

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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0
1

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
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5

Acute Kidney Injury Linked to BRAF Inhibitors in Melanoma

Treatment with vemurafenib and dabrafenib was associated with acute renal toxicity in patients with melanoma, according to data from the FDA Adverse Event Reporting System.  
medscape.com
almost 4 years ago