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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... The GFR will cease when the renal arterial blood pressure is < 50 mmHg... A reduction in renal perfusion due to hypotension results in prostaglandin mediated dilation of the afferent renal arteriole and constriction of the efferent glomerular capillary mediated by angiotensin II... Causes of a low perfusion state are shown in Table 4... Renal hypoperfusion reduces glomerular capillary pressure and the GFR... 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.

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Example of a Surgical AKI risk assessment tool
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fig06: Example of a Surgical AKI risk assessment tool

Mentions: Perioperative AKI is common. Recognition of patients who are at risk will allow measures to be undertaken to reduce exposure to renal insults and maximize renal recovery should AKI occur14. An similar risk assessment tool for use in Surgical patients is shown in Figure 6.


Prevention and management of acute kidney injury.

Harty J - Ulster Med J (2014)

Example of a Surgical AKI risk assessment tool
© Copyright Policy
Related In: Results  -  Collection

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

fig06: Example of a Surgical AKI risk assessment tool
Mentions: Perioperative AKI is common. Recognition of patients who are at risk will allow measures to be undertaken to reduce exposure to renal insults and maximize renal recovery should AKI occur14. An similar risk assessment tool for use in Surgical patients is shown in Figure 6.

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... The GFR will cease when the renal arterial blood pressure is < 50 mmHg... A reduction in renal perfusion due to hypotension results in prostaglandin mediated dilation of the afferent renal arteriole and constriction of the efferent glomerular capillary mediated by angiotensin II... Causes of a low perfusion state are shown in Table 4... Renal hypoperfusion reduces glomerular capillary pressure and the GFR... 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.

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