AKI is common in ICU patients and is associated with high mortality. It is defined based on changes in serum creatinine and urine output. The RIFLE criteria is commonly used for classification. Causes include prerenal, intrinsic renal and post renal factors. Treatment involves identifying and treating the underlying cause, fluid resuscitation, and renal replacement therapy like intermittent hemodialysis or continuous renal replacement therapy as needed. Prevention strategies focus on ensuring adequate perfusion and minimizing nephrotoxins. Outcomes remain poor despite treatment.
Renal Replacement Therapy: modes and evidenceMohd Saif Khan
Renal replacement therapy is a supportive care often required in critically ill patients who develop acute renal failure and its complications. Complexity arises when such patients become hemodynamically unstable and pose special challenge to critical care clinicians in ICU to carefully choose dialytic modality to tackle volume and solute overload. This presentation is about short description of modalities of RRT and current evidence regarding initiation, dose and type of modality.
Renal Replacement Therapy: modes and evidenceMohd Saif Khan
Renal replacement therapy is a supportive care often required in critically ill patients who develop acute renal failure and its complications. Complexity arises when such patients become hemodynamically unstable and pose special challenge to critical care clinicians in ICU to carefully choose dialytic modality to tackle volume and solute overload. This presentation is about short description of modalities of RRT and current evidence regarding initiation, dose and type of modality.
Contrast Induce Nephropathy
its include information about the nephropathy thats caused by the contrast , like in patients undergo PCI or other method of imaging containing contrast
I will discuss the causes with the risk factors then explain the headline of the pathophysiology and clinical presentaion with the mangment,
hepatorenal syndrome is a one of the complication of cirrhosis of liver. It causes hepatic decompensation of liver. It has high risk of mortality. HRS has two types and type 1 usually present as a acute kidney injury. so, at first HRS should exclude from AKI. HRS type 2 present as a refractory ascites. As this has worst prognosis, only valuable management is liver transplantation.
Renal Replacement therapy (Dialytic Management) in AKI - Dr.GawadNephroTube - Dr.Gawad
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/NN9vyWjIPbE
Arabic Language version of this lecture is available at:
https://youtu.be/i-Qlf31Vd-Y
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A very simple yet comprehensive presentation to understand the concept of CRRT and its implementation in Intensive Care Unit. Intended for the very beginners in ICU. After going through the presentation you will be able to say "Now I know it!"
A simple description of a less understood topic in Intensive Care Medicine. Aim to make understanding and management easy for the residents and prevention steps for all ICU workers.
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/e7Ttp4VH0VI
Arabic Language version of this lecture is available at: https://youtu.be/7d5JkPPdHsU
- Visit our website for more lectures: www.NephroTube.com
- Subscribe to our YouTube channel: www.youtube.com/NephroTube
- Join our facebook group: www.facebook.com/groups/NephroTube
- Like our facebook page: www.facebook.com/NephroTube
- Follow us on twitter: www.twitter.com/NephroTube
Contrast Induce Nephropathy
its include information about the nephropathy thats caused by the contrast , like in patients undergo PCI or other method of imaging containing contrast
I will discuss the causes with the risk factors then explain the headline of the pathophysiology and clinical presentaion with the mangment,
hepatorenal syndrome is a one of the complication of cirrhosis of liver. It causes hepatic decompensation of liver. It has high risk of mortality. HRS has two types and type 1 usually present as a acute kidney injury. so, at first HRS should exclude from AKI. HRS type 2 present as a refractory ascites. As this has worst prognosis, only valuable management is liver transplantation.
Renal Replacement therapy (Dialytic Management) in AKI - Dr.GawadNephroTube - Dr.Gawad
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/NN9vyWjIPbE
Arabic Language version of this lecture is available at:
https://youtu.be/i-Qlf31Vd-Y
- Visit our website for more lectures: www.NephroTube.com
- Subscribe to our YouTube channel: www.youtube.com/NephroTube
- Join our facebook group: www.facebook.com/groups/NephroTube
- Like our facebook page: www.facebook.com/NephroTube
- Follow us on twitter: www.twitter.com/NephroTube
A very simple yet comprehensive presentation to understand the concept of CRRT and its implementation in Intensive Care Unit. Intended for the very beginners in ICU. After going through the presentation you will be able to say "Now I know it!"
A simple description of a less understood topic in Intensive Care Medicine. Aim to make understanding and management easy for the residents and prevention steps for all ICU workers.
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/e7Ttp4VH0VI
Arabic Language version of this lecture is available at: https://youtu.be/7d5JkPPdHsU
- Visit our website for more lectures: www.NephroTube.com
- Subscribe to our YouTube channel: www.youtube.com/NephroTube
- Join our facebook group: www.facebook.com/groups/NephroTube
- Like our facebook page: www.facebook.com/NephroTube
- Follow us on twitter: www.twitter.com/NephroTube
Acute Kidney Injury epidemiology, pathophysiology and management based on current evidence. The presentation is suitable for internal medicine trainees and nephrology fellows.
Is life worth living? It depends on the liver by Dr Stephen WarrillowSMACC Conference
Management of the patient with decompensated liver disease is clearly more straightforward in specialist centres with multi-disciplinary input, access to liver transplantation teams and advanced technology. Bioartificial extra-corporeal liver support systems are undergoing evaluation and include the extra-corporeal liver assist device (ELAD developed by Vital Technologies).
ELAD is an investigational, extra-corporeal, human cell-based system. The human liver-derived cells (VTL C3A) may mimic certain functions of in vivo human liver cells. The principles of operation of the ELAD system are as follows: plasma ultrafiltrate is passed through hollow fibre cartridges containing human liver-derived cells (VTL C3A cells) and allowing two-way transfer of toxins, metabolites and nutrients, mimicking liver function. Toxins, such as bilirubin, glucose and oxygen pass from the ultrafiltrate to the VTL C3A cells. Treated plasma ultrafiltrate is then reconstituted with blood cells and returned to the patient. Data evaluating this system shows trends indicating a potential for ELAD to increase survival rates in selected patients with decompensated liver failure.
Issues in the management of liver failure include cardiorespiratory support, and the management of cerebral oedema. The principles for haemodynamic support are as for most critically ill patients, with early restoration of organ perfusion and use of vasopressors if hypotension persists despite restoration of volume. For the patient with liver failure, lactate-containing solutions and fluid overload should be avoided. New monitoring techniques for encephalopathy have been developed, including brain tissue oxygen tension, continuous EEG, transcranial Doppler and cerebral microdialysis.
Key issues for regional centres are basic management principles, liaison with specialist centres and timing of transfer. Who and when to refer is a difficult problem for the regional Australasian unit, given the tyranny of distance and issues relating to retrieval and transfer of the critically ill patient. Early liaison with the regional liver unit is key.
The patient with chronic liver disease presents a range of potential challenges when a severe intercurrent illness occurs or major surgery is required. Even well-compensated liver cirrhosis in high functioning patients renders such individuals vulnerable to a myriad of problems when physiological stressors occur. Severe acute liver failure is another clearly defined sydrome in which extremely rapid and complex multiple organ failure typically ensues. Whilst intensivists are familiar and adept with the management of other major organ failure, new acute liver failure or decompensated chronic liver disease is particularly difficult to manage due to the inherent breadth of roles that the liver has in maintaining health as well as the current lack of comprehensive support therapies other than organ transplantation. While effective artificial life-supports for severe respiratory, cardiac or renal failure are available in the intensive care setting, support for over liver failure is less straightforward. The failing liver inevitably and rapidly impact on every other organ system, necessitating a systematic and comprehensive approach when planning patient care.
As with any dynamic and complex disease process, management is optimised when major clinical problems are anticipated and the detrimental impact is mitigated by the timely application of effective interventions. For patients with severe acute liver failure, a knowledge of the cause, disease trajectory, severity of organ failure as well as early interventions to prevent cerebral oedema are likely to improve outcomes. Specific treatments such as temperature management, respiratory support, osmotherapy and blood purification may be readily applied and reduce the risk of poor outcomes. In the setting of decompensated chronic liver disease, identifying reversible causes of deterioration and proactively managing the resulting predictable problems will ensure the best chance for recovery or stabilisation until subsequent transplantation. The majority of patients can be effectively managed in non-transplant centres, however it is also essential to identify those patients for whom orthotopic liver transplantation is the best or only option for survival. Early discussion with a transplant centre may assist intensivists in deciding who should be transferred and guide the timing of retrieval.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
2. Definition
• Acute kidney injury (AKI) is defined as deterioration of renal function over
hours, days to weeks. The mortality rate of AKI is 50-80% in intensive care
unit (ICU) patients, and has not declined significantly since the initial marked
benefit of acute dialysis therapy.
- ISN (International Society of Nephrology)
• Following long advocacy and persistent work for definition, a system,
RIFLE system was ultimately developed, involving a broad consensus of
experts.
• The acronym RIFLE represents the increasing severity classes Risk, Injury,
and Failure and the two outcome classes Loss and End-Stage Kidney
Disease. The severity grades R–F are defined on the basis of changes in
serum creatinine or urine output, wherein the worst of each criterion is used.
The two outcome criteria, L and E, are defined by the duration of loss of
kidney function.
3. RIFLE & AKIN CRITERIA
Direct comparison of RIFLE (Risk of renal dysfunction,Failure or Loss of kidney function, and End-stage kidney disease)
and Acute Kidney Injury (AKI) Network criteria to classify AKI according to Bellomo et al.7.and Mehta et al.,8.respectively.
4. COMMON CAUSES
Acute Renal Failure
Pre renal
Causes
Intrinsic renal Causes Post renal
Causes
Glomerular
disease
Tubular
Injury
Interstitial
nephritis
Vascula
r
Diseas
e
Ischemic
Toxic
5. Prerenal Causes
• Prerenal (Reduced renal perfusion)
1. Volume Depletion
• Renal loss : diuretics,osmotic diuresis (DKA)
• Extrarenal loss : vomiting,diarrhea,skin losses
• Hemorrhage
• Pancreatitis
2. Hypotension (regardless of cause)
3.Cardiovascular
• Congestive heart failure,reduced myocardial function
• Severe valvular heart disease
8. Post renal ca
• Prostate hypertrophy,neurogenic bladder
• Intraureteral obstruction - crystals stones,clots,tumor.
• Extraureteral obstruction - tumor ( cervical,prostate),
Retro peritoneal fibrosis.
• Ureteric ligation during pelvic surgery.
9. Investigation of Acute Renal Failure
• Blood urea nitrogen and serum creatinin are elevated.
• ABG , electrolytes , CBC and serology.
• U/s kidneys (the size of kidney is usually normal)
• Serology : ANA , ANCA,Anti DNA , HBV , HCV, Anti GBM.
• Urine Analysis :
Differentiates ATN vs AIN vs AGN
Unremarkable in pre and post renal causes
Urine electrolytes and osmolality
• Hansel stain for Eosinophiluria.
10. ARF in ICU
• ARF is common in ICU.
• ARF is an independent factor for prognosis in the ICU.
• The incidence of ARF in the ICU is 40 - 60% compared to 1 - 3% in the ward.
• ARF still has a mortality of 50% since it occurs in very sick patients with multi
organ failure.
• Predisposing factors to ARF include old age sepsis pre existing renal disease
, heart disease and chronic liver disease.
• Mechanical ventilation has an adverse effect on renal blood flow and GFR
and subsequent renal function.
Faber. Nursing in Critical Care 2009; 14: 4 Foot. Current
Anaesthesia and Critical Care 2005; 16: 321 -329
11. Classification
• Patients with ICU acquired ARF were classified into following:
A) According to the urine Output:
1.Oliguric (urine volume of < 400 ml/day)
2.Nonoliguric (urine volume of > 400 ml/day)
3.Anuric (urine volume <100 ml/day)
B) According to the cause:
1. Prerenal ARF
2. Ischemic acute tubular necrosis
3.Nephrotoxic ARF
4.Sepsis induced ARF
5.Hepato Renal Syndrome
6.Other causes (e.g. obstructive uropathy,pigment nephropathy)
12. Prerenal ARF
1.Prerenal ARF
Defined as ARF to renal hypoperfusion with recovery
after correction of hemodynamic disturbances.
2. Ischemic Acute tubular necrosis (IATN)
It is diagnosed when renal function does not improve after correction of
possible prerenal causes.
3.Nephrotoxic ARF :
A)Nephrotoxic Acute Interstitial Nephritis : History of drug ingestion,fever,rash,or
arthritis.
B) Nephrotoxic Acute Tubular Necrosis : was defined as ARF occurring after
administration of drugs known to cause ATN (e.g.,aminoglycosides,amphotericin)
13. 4.Sepsis induced ARF : It is diagnosed if ARF is associated with at least one of
the following three conditions:
A. Documented bacteremia
B. A known focus of infection
C. Immunosuppression with neutropenia
5. Hepatorenal syndrome : It is assigned as the cause of renal failure if the
patient had severe liver failure (e.g. ascites - jaundice,hepatic encephalopathy)
and a urine sodium concentration less than 10 mEq/Litre)
6.Other causes : obstruction was determined to be the cause of renal failure.
14. RRT in AKI
• The initiation of RRT in patients with AKI prevents uremia and immediate
death from the adverse complications of renal failure.
• It is possible that variations in the timing of initiation,modalities, and/or dosing
may affect clinical outcomes.
• Multiple modalities of RRT are currently available.These include intermittent
hemodialysis (IHD), continuous renal replacement therapies (CRRTs), and
hybrid therapies such as sustained low efficiency dialysis (SLED).
• Despite these varied techniques mortality in patients with ARF remains high
greater than 50% in severely ill patients.
15. Dialysis in critically ill patients
1. Indications for dialysis
2. Timing of initiation of dialysis
3. Optimal modality
4. Optimal Dosing
5. Discontinuation of therapy.
16. 1. Refractory fluid overload
2. Hyperkalemia (plasma potassium concentration > 6.5 meq/L)
3. Metabolic acidosis (pH less than 7.1)
4. Signs of uremia e.g. pericarditis and decline in mental state
5. Certain alcohol and drug intoxication.
1.Indications for dialysis in AKI
17. 2.Timing of Initiation of Dialysis
• Studies published during the 1960s and 1970s suggested that improved
outcomes were associated with the initiation of hemodialysis when BUN
reached exceeded 150 to 200 mg/dL.
• More recent studies have evaluated the relationship between the timing of
RRT initiation and clinical outcomes.
• Several non randomized studies have reported that improved
outcomes,including survival,are associated with early versus late initiation of
RRT.
• It has been suggested that initiation of RRT dialysis prior to the development
of covert symptoms and signs of renal failure due to AKI improves the
outcome.
19. Principal of Dialysis
• Dialysis is Passive movement of
solutes across a semi permeable
membrane down concentration
gradient.
• It works on principal for diffusion.
• It is good for small molecules.
• (Ultra) Filtration -
• Convection = solute+fluid removal
across semi permeable membrane
down a pressure gradient (solvent
drag)
• It is better for removal of fluid &
medium size molecule. Faber , Nursing in crital care 2009 ; 14; 4 Foot.
Current Anaesthesia and critical care 2005; 16: 321-329
20. • Oldest and most common technique.
• Primarily diffusive treatment : blood and dialysate are calculated in counter
current manner.
• Also some fluid removal by ultra filtration due to pressure driving through
circuit.
• Best for removal of small molecules.
• Typically performed 4 hours 3× / wk or daily.
Principal of Dialysis
1.Intermittent Hemodialysis(IHD)
21. 2.Continuous Renal Replacement Therapy (CRRT)
• CRRT strategies are particularly useful in haemodynamically compromised
patients with ARF.
• They allow slow and gentle removal of solutes and fluid avoiding major
intravascular fluid shifts and minimizing electrolyte disturbances,hypotension
and arrhythmia.
• Inflammatory mediators may also be continuously removed by CRRT, so it
may be useful in sepsis syndrome.
23. 4.Optimal dosing
• Intermittent dialysis - Dosing in IHD is based upon the dose delivered per
session plus the frequency of sessions.
• Improved survival was observed with a higher Kt/V (greater than 1), which
was particularly evident among patients with intermediate levels of illness
severity.
• Compared with every other day dialysis, daily therapy was associated with a
significant reduction reduction in mortality, fewer hypotensive episodes during
hemodialysis, and more rapid resolution of acute renal failure.
• The randomized evaluation of normal Vs augmented lagal of RRT study and
two meta analyses were performed. All studies found that compared with
standard intensity dialysis, higher intensity dialysis did not result in improved
survival or clinical benefits.
24. 5.Discontinuation of RRT therapy
• RRT is usually continued until the patient manifests evidence of
recovery of kidney function.
1. Increase in urine output
2. A progressive decline in serum creatinine concentration after initial
attainment of stable values
3. Measurement of creatinine clearance e.g. on six hour timed urine
collections obtained when the urine output exceeded 30 ml / hour based on
an average serum creatinine at the beginning and end of the timed
collection.
25. Prevention of AKI
• Identification of patients at high risk to develop AKI are Elderly, DM , Ht .
Sepsis etc...
• Main methods can be
Non Pharmacological Pharmacological
Ensuring adequate hydration
(reversing dehydration)
Loop diuretics
maintenance of adequate mean
arterial pressure
Mannitol
Minimizing exposure to
nephrotoxins
Dopamine &
Fenoldopam
Natriuretic Peptides
26. Non Pharmacological Methods
1. Hydration
• NS,albumin,plasma
• CVP = 8 -12 cm H2O,MAP > 65mmHg.
• Optimal rate of infusion remain unclear & should be individualized.
2. Maintain Renal perfusion pressure
• Target MAP> 65mm Hg.
• Role of low dose dopamine
• Vasopresoors : Noradrenaline is the drug of choice in AKI in Sepsis
• Low dose dopamine should not be used for renal protection in
severe sepsis.
27. Pharmacological Methods
1. Mannitol & Loop Diuretics :
• In animal studies the use of mannitol & loop diuretics minimize the degree of
renal injury if given at the time of ischemic injury.
• Loop diuretics increases the active Na transport in the thick ascending loop
decreasing the energy requirement.
28. Pharmacological Methods
2. ANP & Calcium channel Blockers
• ANP had been tried in experimental models without any
benefit despite their ability to increase renal blood flow and Na
excretion.
• Calcium channel blockers decrease Ca influx to the cells that
lead to cell injury.
• Most human studies were done on established ATN.
• Uncontrolled studies showed that those patients who respond
to diuretics/mannitol may have better outcome but they have
less severe disease.
• Controlled studies failed to show any evidence that low dose
dopamine have any protection in ischemic renal damage.
29. • There is now clear evidence that ARF is associated with excess
mortality,irrespective of whether the patient requires renal
replacement therapy.
• As no drugs are available to enhance renal recovery once arf
occurs, prevention is the only powerful tool to improve outcome of
AKI.
Take Home Message
30. References
• References p p p p Miller: Miller's Anesthesia, 7 th ed. 2009 Uchino S,
Kellum JA, Bellomo R, et al: for the Beginning and Ending Supportive
Therapy for the Kidney (BEST Kidney) Investigators.
• Acute renal failure in critically ill patients: A multinational, multicenter study.
JAMA 2005; 294: 813 -818. Bouman CS, Oudemans-Van Straaten HM,
Tijssen JG, Zandstra DF, Kesecioglu J.
• Continuous versus intermittent renal replacement therapy for critically ill
patients with acute kidney injury: a meta-analysis. Crit Care Med 2008, 36:
610 -617. Rabindranath K, Adams J, Macleod AM, Muirhead N
• Intermittent versus continuous renal replacement therapy for acute renal
failure in adults. Cochrane Database Syst Rev 2007, 3: CD 003773.