Acute renal failure is a dreaded complication in the ICU. This podcast will review the various types of acute renal failure, the etiology, as well as acute management.
Jeffrey S. Guy, MD, FACS
over 11 years ago
Very good case in showing a frequently overlooked issue of diuretics. Remember, there is almost never a reason to give both fluids and diuretics...make up your mind. IV fluids are the #1 method to try in oliguric pts NOT Lasix.Do not agree with Foley cath placement if patient is able to urinate and can check creatinine to know pt is improving. Any catheter is a foreign body and increases infection risk.It is also very uncomfortable for patients.Not sure why U/S of kidney needed right away either unless the patient has chronic kidney disease or does not improve with fluids.Unnecessary tests add to the expense of healthcare which all of us pay for. This increases insurance costs, medicaid costs, etc so much it can put companies (and gov't in the future?) out of business.
almost 7 years ago
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.
almost 7 years ago
This is a good practical case and very useful for new clinicians. For any clinician:No foley catheter unless oliguric, anuric, obstructed since any catheter is a foreign body and increases infection risk.Rehydrate if U/A has high spec gavity, mucous membranes dry, or if BUN is >30 times the creatinine as in this case. Even CHF pts get dry if not in heart failure. If in doubt, do CXR, BNPT, listen for crackles.Start with 250cc IVF if BNPT not less than 150 or give carefully while checking lung bases posteriorly after each bolus along with pulse ox, etc as above. Half of pts in acute renal failure are septic. Look for and eliminate source such as pneumonia, foreign body, pyelonephritis, joint infections. May be afebrile/ low temp or low WBCs with sepsis. Do cultures, check lactate ASAP to detect sepsis BEFORE the BP drops. Lactic acid "the troponin of sepsis." If septic, give a lot of fluids (up to 10 liters often) since capillary leak syndrome will lead to severe hypotension. If septic expect edema to develop with IV boluses yet be aware pt is intravascularly depleted. No pressors without fluids "pressors are not your friend" as per lecturers on Surviving Sepsis campaign.
almost 7 years ago
Failures in basic hospital care are resulting in more than 1,000 deaths a month from the preventable condition acute kidney injury (AKI), an NHS report has found.
about 8 years ago
Italian scientists have designed a dialysis machine specifically to treat babies with acute kidney failure, which they say could improve treatment.
almost 8 years ago
The National Kidney Foundation Primer on Kidney Diseases is your ideal companion in clinical nephrology! From anatomy, histology, and physiology, through the diagnosis and management of kidney disease, fluid and electrolyte disorders, hypertension, dialysis, and kidney transplantation, this trusted manual from Elsevier and the National Kidney Foundation provides an accessible, efficient overview of kidney diseases that's perfect for residency, fellowship, clinical practice, and board review. Incorporate the latest NKF Kidney/ Outcome Quality Initiative guidelines on chronic kidney disease staging and management. Review the basics with a current and practical review of the anatomy, physiology, pathophysiology, diagnosis, and management of kidney disease, fluid and electrolyte disorders, hypertension, dialysis, and renal transplantation. Put the latest knowledge to work in your practice with 8 brand-new chapters including kidney development, assessment of kidney function in acute and chronic settings, the kidney in malignancy, acute tubular injury and acute tubular necrosis, acute interstitial nephritis, Fabry Disease, immunosuppression, and transplant infectious disease, as well as comprehensive updates on acute kidney injury, transplant medicine, kidney function and kidney disease in the elderly, GFR estimation, biomarkers in kidney disease, recently described pathologic targets in membranous nephropathy, minimal change disease, viral nephropathies, and much more! Get expert advice from a new team of editors, led by Scott Gilbert and Dan Weiner from Tufts University School of Medicine, each bringing a fresh perspective and a wealth of clinical experience. Quickly access the complete contents online at Expert Consult, with fully searchable text, downloadable images, and additional figures and graphs.
over 7 years ago