Current opinion in critical care
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Curr Opin Crit Care · Dec 2014
ReviewSepsis-induced acute kidney injury revisited: pathophysiology, prevention and future therapies.
Acute kidney injury (AKI) is a common complication in critically ill patients and is associated with increased morbidity and mortality. Sepsis is the most common cause of AKI. Considerable evidence now suggests that the pathogenic mechanisms of sepsis-induced AKI are different from those seen in other causes of AKI. This review focuses on the recent advances in this area and discusses possible therapeutic interventions that might derive from these new insights into the pathogenesis of sepsis-induced AKI. ⋯ An understanding of the pathologic mechanisms of sepsis-induced AKI emphasizes the important role of maladaptive responses to the septic insult. Preventive and therapeutic measures should be based on counteracting these maladaptive responses of tubular epithelial cells, inflammation, and microvascular dysfunction.
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Curr Opin Crit Care · Dec 2014
ReviewDiagnosis of acute kidney injury: Kidney Disease Improving Global Outcomes criteria and beyond.
Acute kidney injury (AKI) is common. Clear criteria and accurate diagnostic tools are essential to diagnose AKI early and correctly. The aims of this review are to outline some of the pitfalls of the Kidney Disease Improving Global Outcomes (KDIGO) classification and to describe other traditional and novel tools to diagnose AKI. ⋯ Knowledge about the strengths and weaknesses of traditional diagnostic tests is essential to make the correct diagnosis of AKI. New tests and technical innovations offer the prospect of diagnosing AKI earlier and more accurately.
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Curr Opin Crit Care · Dec 2014
ReviewRenal disease presenting as acute kidney injury: the diagnostic conundrum on the intensive care unit.
Acute kidney injury (AKI) is commonplace in most ICUs. In many cases the cause is believed to be multifactorial with sepsis being a major component. However, occasionally intrinsic renal disease will present to the ICU and as such critical care practitioners should be aware of this possibility and the ways in which such conditions may present. ⋯ Not all AKI as described by changes in creatinine and urine output which presents or develops on the ICU is the same. AKI is a syndrome which encompasses many conditions and as such is nondiagnostic. Clinicians, when faced with AKI should satisfy themselves as to the likely cause of the AKI.
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To point out the tolerance of anemia, the possible use of alternatives to allogeneic blood products as well as the pathophysiological effects of transfusions in the context of multiple trauma patients. ⋯ Transfusion in trauma has to be an individual decision for a specific patient, not for a specific laboratory value. Transfusion management must aim at reducing or even avoiding the use of allogeneic blood products. This may lead to a new gold standard with cost reduction and amelioration of outcome of major trauma patients.