Acute Kidney Injury


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Acute Kidney Injury

  1. 1. Acute Kidney InjuryM ChettyGF Jooste Hospital11/10/2011
  2. 2.  Introduction Spectrum of disease Definitions RIFLE AKIN Common causes Biomarkers Prevention Perioperative protection RRT
  3. 3. Introduction ARF - Acute Renal Failure Recent study estimated prevalence as 5.7% Overall mortality proportional to severity of injury Morbidity also an important factor
  4. 4. Spectrum of disease
  5. 5. Definitions ARF (AKI) refers to a sudden decline in kidney function AKI more accuratel represents the spectrum/continuum of the disease However more than 35 definitions exist in the literature Acute Dialysis Quality Initiative ( proposed the RIFLE criteria
  6. 6. RIFLER - riskI - injuryF - failureL - lossE - end stage kidney disease
  7. 7. AKIN
  8. 8. Common causes Five Most Common Causes of AKI in the ICU Sepsis (most common) Major surgery Low cardiac output Hypovolaemia Other Common Causes of AKI in the ICU Hepatorenal syndrome, Trauma, Cardiopulmonary bypass, Abdominal compartment syndrome, Rhabdomyolysis
  9. 9. More common causesNSAIDSAntimicrobials Aminoglycosides Amphotericin PenicillinRadio contrast dye IngestionsEthylene glycol
  10. 10. Yet more causes
  11. 11. Biomarkers Creatinine and creatinine clearance Urea GFR New markers
  12. 12. Biomarkers New Markers Cystatin-C NGAL Kidney injury molecule -1 Interleukin -18
  13. 13. Prevention Maintain renal perfusion Avoid hyperglycaemia Avoid nephrotoxins Diuretics Nutrition
  14. 14. RRT Renal Replacement Therapy (RRT) Blood purification technique using principles of diffusion and ultrafiltration Relies on principle of diffusion Mimic the function and physiology of the kidney Anticoagulation
  15. 15. RRT modalities CVVHD IHD SLEDD
  16. 16. Dialysis HaemofiltrationLMW proteins Adjustable pressure Blood dialysate blood ultrafiltrate Urea
  17. 17. Conclusion
  18. 18. Thank You
  19. 19. References Acute kidney injury in the intensive care unit: An update and primer for the intensivist, Paula Dennen, MD; Ivor S. Douglas, MD; Robert Anderson, MD An Official ATS/ERS/ESICM/SCCM/SRLF Statement: Prevention and Management of Acute Renal Failure in the ICU Patient, Laurent Brochard, Fekri Abroug, Matthew Brenner, Alain F. Broccard, Robert L. Danner, Miquel Ferrer, Franco Laghi, Sheldon Magder, Laurent Papazian, Paolo Pelosi, and Kees H. Polderman The critically ill kidney, Piercy JL, SAJAA 2009; 15(3): 21-26 Acute Renal Failure in Critically Ill Patients A Multinational, Multicenter Study Shigehiko Uchino, MD John A. Kellum, MD Rinaldo Bellomo, MD Gordon S. Doig, PhD Hiroshi Morimatsu, MD Stanislao Morgera, MD Miet Schetz, MD Ian Tan, MD Catherine Bouman, MD Ettiene Macedo, MD Noel Gibney, MD Ashita Tolwani, MD Claudio Ronco, MD Acute Dialysis Quality Initiative, Colloids and crystalloids: does it matter to the kidney? Anthony M. Rochea and Michael F.M. James Acute Kidney Injury in the Intensive Care Unit, Susan T. Crowley, MD, Aldo J. Peixoto, MD