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Prevention and management of acute kidney injury.

Harty J - Ulster Med J (2014)

View Article: PubMed Central - PubMed

Affiliation: Consultant Renal Physician, Daisy Hill Hospital Northern Ireland.

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Two thirds of patients had a significant level of AKI before a diagnosis was made and there was inadequate senior review of these patients... More severe AKI is associated with higher mortality... Temporary cessation of ACEi and ARBs is appropriate in patients with dehydration, hypotension (systolic blood pressure < 110 mmHg) and / or deteriorating renal function... However, hypotension (SBP < 110 mmHg), a postural fall in blood pressure with increase in heart rate, reduction in peripheral perfusion / skin turgor and dry mucous membranes are indicative signs... Large volumes of 0.9% sodium chloride can provoke a hyperchloraemic metabolic acidosis... Failure of the patient to maintain an effective blood pressure following this regime should raise the possibility of underlying sepsis or significant ongoing losses... Absolute hypotension (defined as a SBP < 90 mmHg) has been shown to be associated with the development of AKI following sepsis and major surgery... In patients with AKI and hypotension, blood pressure should be targeted to a MAP of > 65 mmHg... It should be stressed that there is no evidence for a role for “renal dose” dopamine in the management of AKI... In addition, dobutamine has significant vasodilatory effects which can aggravate hypotension and worsen renal perfusion in patients with sepsis and AKI... Antihypertensive medications (including diuretics) should be withheld in patients with both absolute (SBP < 90 mmHg) and relative (SBP < 120 mmHg) hypotension... Patients treated with beta blockers need careful consideration of the risk / benefit of temporary cessation... The indication for dialysis is based on the complications of AKI rather than an absolute value for serum urea, creatinine or GFR... There is no clear benefit for undertaking dialysis solely on the basis of a low GFR.

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Potential outcomes following episode of Acute Kidney Injury
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fig01: Potential outcomes following episode of Acute Kidney Injury

Mentions: There are also two outcome stages - Loss and End Stage Renal Disease (ESRD)7. These stages recognize that AKI can subsequently lead to chronic kidney disease (CKD) and ESRD requiring long term dialysis (Figure 1). Studies in the diabetic population8 have shown that episodes of AKI double the risk of patients developing Stage 4 CKD (estimated GFR 15 – 29 mL/min/1.73m2). Recent NICE Guidelines on CKD recommend monitoring of all patients who recover renal function following an episode of AKI for a minimum of 2 years to ensure early detection and management of CKD3.


Prevention and management of acute kidney injury.

Harty J - Ulster Med J (2014)

Potential outcomes following episode of Acute Kidney Injury
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4255835&req=5

fig01: Potential outcomes following episode of Acute Kidney Injury
Mentions: There are also two outcome stages - Loss and End Stage Renal Disease (ESRD)7. These stages recognize that AKI can subsequently lead to chronic kidney disease (CKD) and ESRD requiring long term dialysis (Figure 1). Studies in the diabetic population8 have shown that episodes of AKI double the risk of patients developing Stage 4 CKD (estimated GFR 15 – 29 mL/min/1.73m2). Recent NICE Guidelines on CKD recommend monitoring of all patients who recover renal function following an episode of AKI for a minimum of 2 years to ensure early detection and management of CKD3.

View Article: PubMed Central - PubMed

Affiliation: Consultant Renal Physician, Daisy Hill Hospital Northern Ireland.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Two thirds of patients had a significant level of AKI before a diagnosis was made and there was inadequate senior review of these patients... More severe AKI is associated with higher mortality... Temporary cessation of ACEi and ARBs is appropriate in patients with dehydration, hypotension (systolic blood pressure < 110 mmHg) and / or deteriorating renal function... However, hypotension (SBP < 110 mmHg), a postural fall in blood pressure with increase in heart rate, reduction in peripheral perfusion / skin turgor and dry mucous membranes are indicative signs... Large volumes of 0.9% sodium chloride can provoke a hyperchloraemic metabolic acidosis... Failure of the patient to maintain an effective blood pressure following this regime should raise the possibility of underlying sepsis or significant ongoing losses... Absolute hypotension (defined as a SBP < 90 mmHg) has been shown to be associated with the development of AKI following sepsis and major surgery... In patients with AKI and hypotension, blood pressure should be targeted to a MAP of > 65 mmHg... It should be stressed that there is no evidence for a role for “renal dose” dopamine in the management of AKI... In addition, dobutamine has significant vasodilatory effects which can aggravate hypotension and worsen renal perfusion in patients with sepsis and AKI... Antihypertensive medications (including diuretics) should be withheld in patients with both absolute (SBP < 90 mmHg) and relative (SBP < 120 mmHg) hypotension... Patients treated with beta blockers need careful consideration of the risk / benefit of temporary cessation... The indication for dialysis is based on the complications of AKI rather than an absolute value for serum urea, creatinine or GFR... There is no clear benefit for undertaking dialysis solely on the basis of a low GFR.

Show MeSH
Related in: MedlinePlus