Nephron. Physiology
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Many radiographic studies and procedures use iodinated contrast media and consequently pose the risk of contrast-induced acute kidney injury (AKI). This is an important complication, which accounts for a significant number of cases of hospital-acquired renal failure associated increased hospital length of stay and increased mortality. ⋯ Avoidance of dehydration and multimodality prevention measures may reduce rates of this problem in patients at risk. Contrast-induced AKI is likely to remain a significant challenge for specialists in the future since the patient population is aging, chronic kidney disease and diabetes are coming more common, and use of iodinated contrast is growing.
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Nephron. Physiology · Jan 2008
Review Meta AnalysisCardiac surgery-associated acute kidney injury: putting together the pieces of the puzzle.
Acute kidney injury (AKI) is a common problem in the context of cardiac surgery. There are both similarities and differences with AKI occurring in other clinical scenarios. In this paper, we discuss those aspects of AKI that are particular to cardiac surgery-associated AKI (CSA-AKI), with emphasis on recent advances in the field. ⋯ CSA-AKI remains a clinically relevant problem for 5-10% of cardiac surgery patients and is associated with adverse clinical outcomes. Small changes in serum creatinine are important and should not be ignored. The overall incidence of new dialysis after cardiac surgery remains low.
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Changes in urine output and glomerular filtration rate are neither necessary nor sufficient for the diagnosis of renal pathology. Yet no simple alternative for the diagnosis currently exists. Until recently, there has been no consensus as to diagnostic criteria or clinical definition of acute renal failure. ⋯ Thus, AKI is not acute renal failure but a more general description. Small changes in kidney function in hospitalized patients are important and are associated with significant changes in short and possibly long-term outcomes. The RIFLE criteria provide a uniform definition of AKI and have now been validated in numerous studies.
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Nephron. Physiology · Jan 2008
ReviewNew insights on intravenous fluids, diuretics and acute kidney injury.
Acute kidney injury (AKI) is commonly and increasingly encountered in patients with critical illness. Fluid therapy is the cornerstone for the prevention and management of critically ill patients with AKI. New data have emerged that have raised concern that specific types of fluid (i.e. hydroxyethylstarch) may either contribute to or exacerbate AKI. ⋯ There are few therapeutic interventions proven to impact the clinical course and outcome of critically ill patients with established AKI. Current management strategies center largely on supportive care, with rapid resuscitation, removal of the stimulus contributing to AKI, judicious avoidance of complications, and allowing time for recovery. In this review, we explore recent insights on intravenous fluid therapy, volume overload, and diuretic therapy in the context of the critically ill patients with AKI.
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Nephron. Physiology · Jan 2008
Clinical TrialAn assessment of symptomatic relief after carpal tunnel release in patients on haemodialysis.
Patients receiving haemodialysis for chronic kidney disease are at risk of developing beta(2)-microglobulin-related carpal tunnel syndrome (CTS). There is a lack of evidence regarding outcome of this complication following surgical treatment. The current study specifically addressed the relief of symptoms after carpal tunnel release in this particular group of patients. ⋯ Release of carpal tunnel in patients on haemodialysis helps alleviation of symptoms due to median nerve compression and improves the function of hand and quality of life in the majority of patients. There can still be a small minority of patients who may not show any improvement and a few may rarely get worse.