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The patient with acute renal problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Acute kidney injury is classified according to the degree of blood chemistry impairment and the extent to which the urinary output is abnormal. In 2012, the Kidney Disease: Improving Global Outcomes AKI working group devised the current KDIGO staging system (KDIGO 2012). This is outlined in Table 8.1. This system of staging was devised from two previous AKI staging systems, the RIFLE and AKIN criteria.
Applied Physiology: Renal Failure
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
Renal failure is classified into two main categories: Acute kidney injury (AKI). In AKI, there is a loss of kidney function within a few days. Acute renal failure refers to severe acute kidney injury in which the kidneys abruptly stop entirely or almost entirely and requiring renal replacement therapy.Chronic kidney disease. There is progressive loss of kidney function over a period of months or years (Table 46.1).
Postoperative complications
Published in Tom Cecil, John Bunni, Akash Mehta, A Practical Guide to Peritoneal Malignancy, 2019
Acute kidney injury is mostly transient and caused by pooling of fluid in compartments outside the effective circulation, but may be exacerbated by nephrotoxic medication (analgesia, antibiotics, etc.) and ureteric injury/obstruction. Adequate fluid resuscitation forms the key to prevention. Furthermore, sodium thiosulfate can be administered when cisplatin is used as intraperitoneal chemotherapeutic agent (e.g. 9 g/m2 in 200 mL intravenous bolus at the start of perfusion followed by continuous infusion of 12 g/m2 over 6 hours).
Actual drug-related harms in residential aged care facilities: a narrative review
Published in Expert Opinion on Drug Safety, 2022
Sheraz Ali, Colin M. Curtain, Luke RE. Bereznicki, Mohammed S. Salahudeen
Acute kidney injury is an abrupt decrease in kidney function, occurring within hours and resulting in the accumulation of urea and other metabolic waste products and the dysregulation of extracellular volume and electrolytes [51]. RACF residents are at high risk for acute kidney injury owing to age-related changes in kidney structure and function [51]. Handler et al. reported that 30% (n = 38) of older residents usually experience acute kidney injury within 100 days of admission to RACFs [51]. The occurrence of a drug-related acute kidney injury is often due to the use of diuretics, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, antibiotics, and non-steroidal anti-inflammatory drugs [51]. Clinical information systems using computerized alerts may help in the early detection of complications associated with acute kidney injury, as predicting acute kidney injury from underlying risk factors is challenging in older people [51]. Although acute kidney injury is well-studied in the acute care setting, evidence related to drug-induced acute kidney injury in RACFs is limited. Future research is needed to determine if deprescribing some renally-eliminated medications can positively impact the incidence and progression of acute kidney injury in older people living in RACFs.
COVID-19 causing rhabdomyolysis requiring hemodialysis in a young adult
Published in Baylor University Medical Center Proceedings, 2022
Nitish Mittal, Gaspar Del Rio-Pertuz, Mostafa Abohelwa
We hypothesized that our case involved kidney injury due to heme pigment-associated acute tubular necrosis from past SARS-CoV-2. Some research has speculated that there is a component of direct cellular damage from the virus via angiotensin-converting enzyme 2 in kidney cells.11 The same mechanism is most likely also involved in the liver with elevated liver enzymes.12 Proposed therapies of COVID-19, including remdesivir and hydroxychloroquine, are contraindicated in severe kidney failure. Acute kidney injury increases morbidity and likely mortality in these patients.13 Subsequently, more complicated cases require renal replacement therapy, which is not available in resource-limited areas. Moreover, there has been an increase in troponin in some cases due to cross-reactivity between creatinine kinase and fifth-generation high-sensitivity troponin.14
Prevalence, clinical characteristics and outcomes of hypoxic hepatitis in critically ill patients
Published in Scandinavian Journal of Gastroenterology, 2022
Sigrún Jonsdottir, Margrét B. Arnardottir, Jóhannes A. Andresson, Helgi K. Bjornsson, Sigrun H. Lund, Einar S. Bjornsson
Acute kidney injury was defined as: (a) increase in serum creatinine by ≥0.3 mg/dL (≥26.5 µmol/L) within 48 h or (b) increase in serum creatinine to ≥1.5 times baseline, which is known or presumed to have occurred within the prior seven days or (c) urine volume <0.5 mL/kg/hour for six hours [14]. Rhabdomyolysis was defined by a CK cut-off value of CK >5xULN in the appropriate clinical setting [15,16]. Acute pancreatitis (AP) was defined by abdominal pain, amylase and/or lipase value >3xULN and/or features of pancreatitis on imaging studies (abdominal ultrasound and/or CT). Two out of these three criteria were required for the diagnosis of AP [17]. Diagnosis of IP required a clinical setting of circulatory shock, arterial hypotension, hypovolemia and/or arterial hypoxemia (PaO2 of <60 mmHg (8.0 kPa or less)) prior to the diagnosis of AP without a prior history of abdominal pain to this episode. All other causes of AP, such as biliary and alcohol induced AP, were ruled out. Intestinal ischemia was defined as ischemia identified by laparotomy, laparoscopy or by autopsy.