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A timely update Acute kidney injury (AKI) is a serious and as yet incompletely understood disorder in which sudden impairment of kidney function occurs secondary to one or more of a variety of underlying conditions. This disorder is very common in (elderly) ICU patients and is associated with very high mortality. Many of those who survive suffer from permanent kidney failure and other long-term morbidities, which may include cardiovascular disease and immune dysfunction. Epidemiologic evidence suggests that AKI is not a single disease, but a syndrome comprised of multiple, often coexisting, etiologies. Being usually part of multiorgan failure syndrome, it calls for multiple organ support therapy. The publication at hand contains sections on prerenal azotemia syndromes, dying of' or with' AKI, pathophysiology of sepsis- induced acute kidney injury, developments in prevention / treatment / rehabilitation, and renal support. Reporting the latest recommendations from experts, it provides valuable information for those that are interested in understanding the disorder and its treatment options.
Continuous Renal Replacement Therapy provides concise, evidence-based, bedside guidance for the management of critically ill patients with acute renal failure, offering quick reference answers to clinicians' questions about treatments and situations encountered in daily practice.
Acute Kidney Injury (AKI) is a complex syndrome that is prevalent among hospitalized patients. In recent years, occurrence of AKI events has risen due to a growing susceptibility of fragile and elderly subjects and an increase in the use of complex procedures such as cardiovascular surgery and imaging techniques. Exposure to potentially nephrotoxic drugs, such as new chemotherapeutic agents, is also proving to be a cause of AKI. This book summarizes recent advances in various settings. A reappraisal of current definitions and staging classifications for AKI in the literature is followed by a description of new criteria for identifying patients at risk and characterizing early kidney damage by using biomarkers. Other important topics include the sequelae of AKI and AKI in special populations such as children, the elderly, and those with cancer. The effects of AKI and its consequences on healthcare expenditures are also addressed from several perspectives. AKI management requires the cooperation of different specialists to optimize outcomes. This book is thus a perfect tool not only for nephrologists, but for every specialist involved in the complicated endeavor of improving patient care.
Acute kidney injury is defined as an abrupt change in serum creatinine and/or urine output, and a majority of patients admitted to the ICU have some evidence of the disorder. Unfortunately, treatment for this complex syndrome is as yet lacking and understanding is limited. An interdisciplinary panel of experts has contributed to this volume, illuminating some of the fundamental and complex aspects of the disorder ranging from pathophysiology to treatment, from emerging biomarkers to genetic polymorphisms. Other contributions focus on immunological issues or the many complications of acute kidney injury and co-morbid conditions encountered, covering the fundamentals as well as the latest developments. Moreover, important technical aspects of extracorporeal therapies including vascular access, anticoagulation or fluid composition are introduced, and different approaches to renal support from intermittent dialysis to continuous therapies and hybrid techniques are discussed. A description of advanced extracorporeal techniques of organ support and their role in the management of sepsis and acute kidney injury in the context of an overall strategy of multi-organ failure management concludes the discussions. This volume not only provides a practical and up-to-date summary of current knowledge and technology, but also imparts a fundamental understanding of the pathogenesis and likely future developments in this field. It also serves to challenge and re-examine the fundamental underlying assumptions we hold regarding critical illness in general and acute kidney injury in particular.
Acute kidney injury (AKI), previously called acute renal failure, has chiefly been described as a syndrome since World War 2. Traditionally 'acute renal failure' was regarded as a less common organ failure, with patients typically requiring dialysis and managed by nephrologists. This view has now been overturned. AKI encompasses a wide spectrum of injury to the kidneys, not just kidney failure. It is a common problem amongst hospitalised patients, in particular the elderly population whose numbers are increasing as people live longer. Such patients are usually under the care of doctors practicing in specialties other than nephrology. For normal function the kidneys require a competent circulation. Conversely, it is known that renal function is vulnerable to even relative or quite modest hypotension or hypovolaemia. Hence AKI is a feature of many severe illnesses. Although these illnesses may affect many organs, the simple process of monitoring urine output and/or creatinine permits detection of AKI. There have long been concerns that clinicians may inadvertently contribute to the development of AKI, by their use of drugs that are harmful to the kidneys. However, in spite of its wider adoption in the UK from the 1970's, audit was not fully applied to AKI until the turn of the millennium. A seminal moment was the confidential enquiry into the deaths of a large group of adult patients with AKI, published by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) in 2009. This described systemic deficiencies in the care of patients who died of AKI including failures in AKI prevention, recognition, therapy and timely access to specialist services. Only 50% of these sick patients received 'good' care. It was clear that many adult specialties needed to greatly improve their recognition and management of AKI and redesign their services. There are also known and unacceptable variations in the recognition, assessment, initial treatment and usage of renal replacement therapy in AKI. Some 20-30% of cases of AKI are regarded partially or fully preventable. Even if only 20% of cases can be prevented or ameliorated, successful preventive measures would produce a large reduction in deaths, complications and costs due to AKI. The NCEPOD report informed a referral from the Department of Health for NICE to develop its first guideline on AKI. The guideline development process is defined by its scope, published after stakeholder consultation. Therefore, the guideline does not cover all aspects of AKI, only addressing areas within the scope. Importantly these guidelines include paediatric acute kidney injury. The scope of the guideline focuses on identifying clinical and cost effective practice that might improve care and outcomes in intervention in the earlier parts of the disease process, including risk assessment and prevention, early recognition and treatment. It does not include evidence regarding aspects of dialysis beyond the decision on its initiation. NICE guidance does not aim to provide a 'textbook' of care for the area under consideration. Thus it is beyond the scope of the guideline to give detailed discussion of the more basic management of AKI causes such as hypovolaemia, sepsis, and nephrotoxins. Instead it aims to distil relevant evidence and use this to provide a set of recommendations. It is primarily aimed at generalist clinicians, who will care for the large majority of patients with AKI in a non-specialist hospital or primary care setting.
Acute kidney injury (AKI) is a serious and as yet incompletely understood disorder in which sudden impairment of kidney function occurs secondary to one or more of a variety of underlying conditions. This disorder is very common in (elderly) ICU patients and is associated with very high mortality. Many of those who survive suffer from permanent kidney failure and other long-term morbidities, which may include cardiovascular disease and immune dysfunction. Epidemiologic evidence suggests that AKI is not a single disease, but a syndrome comprised of multiple, often coexisting, etiologies. Being usually part of multiorgan failure syndrome, it calls for multiple organ support therapy.The publication at hand contains sections on prerenal azotemia syndromes, dying ‘of’ or ‘with’ AKI, pathophysiology of sepsis-induced acute kidney injury, developments in prevention / treatment / rehabilitation, and renal support. Reporting the latest recommendations from experts, it provides valuable information for those that are interested in understanding the disorder and its treatment options.
This book presents up-to-date information on the clinical-pathophysiological features of acute renal injury and discusses the KDIGO diagnostic criteria, as well as novel experimental findings, including in the area of regenerative medicine. It also highlights the clinical-pathophysiological importance of AKI in clinical settings, including differential diagnoses and management of AKI. In the past, the pathology associated with sudden renal impairment was characterized as acute renal failure (ARF). However, in the 2000s, the joint efforts of specialists in fields including nephrology, intensive care medicine, and cardiovascular medicine led to the introduction of a novel concept known as acute kidney injury (AKI). As medical care progressed, patients such as high-risk elderly subjects who were not deemed to be candidates for invasive therapy came to be treated in intensive care units (ICUs). As a result, kidney injury as a subset of multiple organ failure was re-considered as AKI, especially in intensive care medicine. AKI was then proposed as a novel disease concept to emphasize the importance of early diagnosis and early intervention to improve prognosis.Presenting novel features, such as the definition of AKI, risk factors and management; biomarkers, such as neutrophil gelatinase-associated lipocalin (NGAL) and L-type fatty acid-binding protein (L-FABP); long-term outcomes of AKI; as well as renal regeneration using iPS cell, manipulation of embryonic genes, and Xenotransplanted embryonic kidney, this book is of interest to all physicians and researchers in this field around the globe.
This comprehensive guide covers the causes, characteristics, and presentations of acute kidney injury (AKI), as well as prevention and treatment. The first part of the book features chapters on the epidemiology and diagnosis of AKI. This is followed by sections on pathophysiology, clinical syndromes and patient management. Authored by leading clinicians, epidemiologists, basic scientists, and clinical trialists, this book captures the latest evidence and best practices for treating patients with AKI.
The kidneys participate in all vital processes of the body to maintain overall homeostasis and health. When kidneys are injured during surgical interventions, metabolic and hemodynamic control is disrupted, leading to dysfunction associated with greater mortality, length of hospital stay and cost. Peri-operative Kidney Injury presents the epidemiology, risk factors, diagnosis, treatment and outcomes associated with kidney injury during the peri-operative period. Concepts and principles of care to prevent kidney complications during surgical procedures are provided to equip health care professionals along with strategies to manage acute kidney injury and associated challenges when they occur. Chapters detail diverse surgical settings, ranging from the more common, such as abdominal, cardiac and vascular surgeries, to the intricately complex, including the use of the left ventricular assist device and organ transplants. This practical and comprehensive text blends the evidence-based standards of care with cutting edge advances in the field, while also providing the reader with a peek into innovations on the horizon.