Acute Nephrology for the Critical Care Physician by Heleen M. Oudemans-van Straaten, Lui G. Forni, A.B. Johan

By Heleen M. Oudemans-van Straaten, Lui G. Forni, A.B. Johan Groeneveld, Sean M. Bagshaw, Michael Joannidis

This sensible advisor presents the reader with solutions to special clinically suitable questions in regards to the evaluate and administration of acute kidney harm (AKI). All points of severe care nephrology are coated, from pathophysiology and analysis to prevention and remedy. The questions thought of relate to a variety of concerns, similar to: How do I diagnose AKI? How am i able to guard the kidney in medical perform? How do I deal with sufferers with AKI? whilst may still I start up and the way do I practice renal substitute treatment (RTT)? which sort of RTT is best suited for my sufferer? may still I supply particular food? as well as supplying functional guidance and remedy algorithms, the e-book comprises calculators for non-stop RRT and anticoagulant dosing. The authors are across the world popular specialists within the fields of in depth Care drugs and Nephrology and all contributions are written in a transparent and concise kind and feature been peer reviewed. Acute Nephrology for the serious Care Physician will function a truly precious resource for intensivist internists, anesthesiologists and nephrologists focused on the administration and remedy of severely ailing sufferers susceptible to or plagued by AKI.

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Endotoxin induces the activation of iNOS, leading to the formation of intracellular ROS and reactive nitrogen species (RNS) [25, 26]. Intracellular ROS and RNS are able to damage mitochondria, leading to apoptosis. In addition, iNOS-derived NO enables shedding of tubular epithelial cells by cytokines [27]. In an attempt to mitigate renal injury caused by iNOS, septic patients were treated with an NO-synthetase inhibitor. Although this treatment increased the percentage of shock reversal, it did not change the incidence of AKI [28].

2012;40(4):1164–70. 28. Coca SG, Peixoto AJ, Garg AX, Krumholz HM, Parikh CR. The prognostic importance of a small acute decrement in kidney function in hospitalized patients: a systematic review and meta-analysis. Am J Kidney Dis Off J Natl Kidney Found. 2007;50(5):712–20. 29. Bagshaw SM, Uchino S, Bellomo R, et al. Septic acute kidney injury in critically ill patients: clinical characteristics and outcomes. Clin J Am Soc Nephrol. 2007;2(3):431–9. 30. Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study.

J. M. Oudemans-van Straaten et al. M. de Pont et al. clarity we separately discuss AKI etiologies, although it should be reemphasized that in the real world these mechanisms often coexist [3–5]. 2 Sepsis Nearly 50 % of the cases of AKI in the intensive care unit occur in the context of sepsis [1]. We will briefly summarize mechanisms of sepsis-induced AKI. 1 Renal Hemodynamics in Sepsis While a fall in renal blood flow has been considered an important factor in septic AKI, there is growing evidence that blood flow to the kidneys may not be severely compromised in septic shock and that an inflammatory component is largely responsible for a decline in renal function [6].

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