Contributions to nephrology
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Acute kidney injury (AKI) is a major medical problem in critical illness, and has a separate independent effect on the risk of death. Septic shock and cardiac surgery utilizing cardiopulmonary bypass are the two most common factors contributing to AKI. Clinical predictors and biochemical markers identified for the development of AKI can only explain a part of this individual risk. ⋯ However, to date our knowledge on the importance of such genetic polymorphisms in influencing the susceptibility to and severity of AKI remains limited. There is evidence that several genetic polymorphisms accounting for sepsis- or cardiopulmonary bypass-associated AKI involve genes which participate in the control of inflammatory or vasomotor processes. In this article, we will review current knowledge concerning the role of genetic polymorphism in the pathogenesis of sepsis- and cardiopulmonary bypass-associated AKI and discuss possible areas for future developments and research in this field.
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Acute renal failure is a common complication in critically ill patients, affecting some 25% of intensive care unit (ICU) admissions, and is associated with high mortality rates of around 40-50%. Acute renal failure in the ICU frequently occurs as part of multiple organ failure (MOF). ⋯ ICU patients with acute renal failure should be managed using a multidisciplinary team approach led by an intensivist. Good collaboration and communication between intensivists and renal and other specialists is essential to insure the best possible care for ICU patients with renal disease.
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The questions as to which treatment is the most effective for the replacement of renal function in critically ill patients with acute renal failure and the qualifications needed by nurses to manage the continuous renal replacement therapy (CRRT) device are part of an ongoing debate between nephrologists and intensivists, between nurses of the renal ward and the ICU. ⋯ Initiating and maintaining a CRRT program is a great challenge for the ICU nurse. The possible problems remain within the ICU staff's ability to solve if they follow an education program. If the workload for the nurses is well monitored, extra personnel can be avoided.
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Acute kidney injury (AKI) is a major clinical problem with a rising incidence and high mortality rate. The lack of early biomarkers has resulted in an unacceptable delay in initiating therapies. ⋯ As they represent tandem biomarkers, it is likely that the AKI panels will be useful for timing the initial insult and assessing the duration and severity of AKI. Based on the differential expression of the biomarkers, it is also likely that the AKI panels will distinguish between the various types and etiologies of AKI. It will be important in future studies to validate the sensitivity and specificity of these biomarker panels in clinical samples from large cohorts and from multiple clinical situations.
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The application of modern quantitative physical chemical techniques to clinical acid-base has yielded important new information about the nature and clinical significance of metabolic acid-base disorders. Abnormalities identified by the strong ion gap appear to be common in critically ill patients and are associated with increased mortality especially when identified early in the course of critical illness. Attempts to identify the exact chemical nature of ions identified by the strong ion gap have only been of limited success and further study is needed.