Menu Expand
Nephrology, An Issue of Critical Care Clinics, E-Book

Nephrology, An Issue of Critical Care Clinics, E-Book

John A. Kellum

(2016)

Additional Information

Abstract

Dr. John Kellum has assembled an essential update on the topic of Nephrology as it relates to Critical Care Medicine. Articles include: Diagnostic criteria, Biomarkers for AKI, Sepsis-induced AKI,Drug-induced AKI, Cardio-renal syndrome,Surgery Associated AKI,Contrast-induced AKI, Principles of Fluid Therapy,Fluid composition and clinical effects, Renal replacement therapy, and Understanding acid-base.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Nephrology i
Copyright\r ii
Contributors iii
CONSULTING EDITOR iii
EDITOR iii
AUTHORS iii
Contents vii
Preface: Critical Care Nephrology\r vii
Diagnostic Criteria for Acute Kidney Injury: Present and Future\r vii
Biomarkers in Acute Kidney Injury\r vii
Sepsis-Induced Acute Kidney Injury\r vii
Thrombocytopenia-Associated Multiple Organ Failure and Acute Kidney Injury\r vii
Drug-Induced Acute Kidney Injury: A Focus on Risk Assessment for Prevention\r viii
A Clinical Approach to the Acute Cardiorenal Syndrome\r viii
Acute Kidney Injury in the Surgical Patient\r viii
Contrast-associated Acute Kidney Injury\r ix
Acute Kidney Injury in Cirrhosis\r ix
Short-term Effects of Acute Kidney Injury\r ix
Long-Term Follow-up of Acute Kidney Injury\r ix
Preventing Acute Kidney Injury\r x
Principles of Fluid Management\x0B x
Fluid Overload\r x
Fluid Composition and Clinical Effects\r x
Renal Replacement Therapy\r xi
Understanding Acid Base Disorders\r xi
CRITICAL CARE CLINICS\r xii
FORTHCOMING ISSUES xii
January 2016 xii
April 2016 xii
July 2016 xii
RECENT ISSUES xii
July 2015 xii
April 2015 xii
January 2015 xii
Preface: Critical Care Nephrology xiii
REFERENCES xiv
Diagnostic Criteria for Acute Kidney Injury 621
Key points 621
INTRODUCTION 621
CRITERIA FOR ACUTE KIDNEY INJURY 622
THE PURPOSE OF STANDARDIZED CRITERIA FOR ACUTE KIDNEY INJURY 622
BASELINE RENAL FUNCTION 624
SERUM CREATININE AND URINE OUTPUT 626
NOVEL BIOMARKERS 628
DIAGNOSTIC UNCERTAINTY AND FUTURE CLASSIFICATION SYSTEMS 629
REFERENCES 630
Biomarkers in Acute Kidney Injury 633
Key points 633
INTRODUCTION 633
SUMMARY OF KEY BIOMARKERS 635
CLINICAL SETTINGS 635
Cardiac Surgery 635
Critical Illness and Sepsis 638
Emergency Department 641
DISCRIMINATORY FUNCTION 642
SUMMARY 643
REFERENCES 643
Sepsis-Induced Acute Kidney Injury 649
Key points 649
INTRODUCTION 649
THE KIDNEYS' RESPONSE TO SEPSIS 650
Cellular Adaptation 650
GLOMERULAR HEMODYNAMICS IN SEPTIC ACUTE KIDNEY INJURY 651
MANAGEMENT OF PATIENTS WITH SEPTIC ACUTE KIDNEY INJURY 652
Systemic Blood Pressure 652
Fluid Management and Central Venous Pressure 654
Vasopressor Therapy 654
Red Blood Cell Transfusion 654
Renal Replacement Therapy 654
FUTURE THERAPIES 655
SUMMARY 656
REFERENCES 656
Thrombocytopenia-Associated Multiple Organ Failure and Acute Kidney Injury 661
Key points 661
INTRODUCTION 661
THROMBOTIC THROMBOCYTOPENIA PURPURA 662
Von Willebrand Factor and ADAMTS-13 in Thrombotic Thrombocytopenic Purpura 662
Thrombotic Thrombocytopenic Purpura and Acute Kidney Injury 663
Managing Thrombotic Thrombocytopenic Purpura 664
HEMOLYTIC UREMIC SYNDROME 664
Shiga Toxins and Complement Pathway in Hemolytic Uremic Syndrome 665
Hemolytic Uremic Syndrome and Acute Kidney Injury 665
Managing Hemolytic Uremic Syndrome 665
DISSEMINATED INTRAVASCULAR COAGULATION 666
Tissue Factor in Disseminated Intravascular Coagulation 666
Disseminated Intravascular Coagulation and Acute Kidney Injury 666
Managing Disseminated Intravascular Coagulation 667
THROMBOCYTOPENIA-ASSOCIATED MULTIPLE ORGAN FAILURE 667
Thrombocytopenia-Associated Multiple Organ Failure and Acute Kidney Injury 668
Managing Thrombocytopenia-Associated Multiple Organ Failure (Not Overt Disseminated Intravascular Coagulation, Thrombotic T ... 668
REFERENCES 668
Drug-Induced Acute Kidney Injury 675
Key points 675
EPIDEMIOLOGY OF DRUG-INDUCED ACUTE KIDNEY INJURY 675
RISK FACTORS FOR DRUG-INDUCED ACUTE KIDNEY INJURY 676
RISK ASSESSMENT FOR DRUG-INDUCED ACUTE KIDNEY INJURY 677
PREVENTION OF DRUG-INDUCED ACUTE KIDNEY INJURY 679
MANAGEMENT OF DRUG-INDUCED ACUTE KIDNEY INJURY 680
FUTURE DIRECTIONS 680
SUMMARY 681
REFERENCES 681
A Clinical Approach to the Acute Cardiorenal Syndrome 685
Key points 685
INTRODUCTION 685
EPIDEMIOLOGY OF ACUTE CARDIORENAL SYNDROME 686
BIOMARKERS IN ACUTE CARDIORENAL SYNDROME 686
PATHOPHYSIOLOGY OF CARDIORENAL SYNDROME 690
CLINICAL ASSESSMENT OF CARDIORENAL SYNDROME 691
TREATMENT OF CARDIORENAL SYNDROME 692
Diuretic Therapy 693
Vasoactive Drugs 694
Extracorporeal Volume Removal 695
SUMMARY 696
REFERENCES 696
Acute Kidney Injury in the Surgical Patient 705
Key points 705
INTRODUCTION 705
DEFINITIONS, EPIDEMIOLOGY, AND OUTCOMES ASSOCIATED WITH PERIOPERATIVE ACUTE KIDNEY INJURY 706
RISK FACTORS FOR ACUTE KIDNEY INJURY 707
RISK STRATIFICATION FOR ACUTE KIDNEY INJURY 710
Use of Imaging Techniques 710
Use of Urine and Plasma Biomarkers 711
Use of Clinical Prediction Scores 712
PREVENTION AND TREATMENT OF PERIOPERATIVE ACUTE KIDNEY INJURY 713
SUMMARY 715
REFERENCES 715
Contrast-associated Acute Kidney Injury 725
Key points 725
INTRODUCTION 725
RISK FACTORS FOR CONTRAST-ASSOCIATED ACUTE KIDNEY INJURY 726
INCIDENCE OF CONTRAST-ASSOCIATED ACUTE KIDNEY INJURY 727
OUTCOMES ASSOCIATED WITH CONTRAST-ASSOCIATED ACUTE KIDNEY INJURY 727
PREVENTION OF CONTRAST-ASSOCIATED ACUTE KIDNEY INJURY 729
Contrast Agents 729
Renal Replacement Therapies 729
Pharmacologic Agents 729
Intravenous Fluids 730
Current Recommendations for Prevention 730
SUMMARY 731
REFERENCES 731
Acute Kidney Injury in Cirrhosis 737
Key points 737
INTRODUCTION 738
EPIDEMIOLOGY 738
PATHOPHYSIOLOGY OF HEPATORENAL SYNDROME 738
PATHOPHYSIOLOGY OF ACUTE KIDNEY INJURY IN CIRRHOSIS: INFLAMMATION? 739
ASSESSMENT OF RENAL DYSFUNCTION 739
ACUTE KIDNEY INJURY IN PATIENTS WITH LIVER DISEASE: DIAGNOSIS AND DEFINITIONS 741
ACUTE KIDNEY INJURY IN CIRRHOSIS: NOVEL BIOMARKERS 741
THERAPIES: HEPATORENAL SYNDROME 743
ALBUMIN 743
VASOCONSTRICTOR THERAPY 743
Vasopressin Analogues 743
Noradrenaline 744
Midodrine and Octreotide 744
TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT 744
RENAL REPLACEMENT THERAPY 745
EXTRACORPOREAL LIVER SUPPORT 745
TREATMENT: OTHER CAUSES OF ACUTE KIDNEY INJURY 746
NATURAL HISTORY OF ACUTE KIDNEY INJURY: PRETRANSPLANT AND POSTTRANSPLANT OUTCOMES 746
SUMMARY 746
REFERENCES 747
Short-term Effects of Acute Kidney Injury 751
Key points 751
INTRODUCTION 751
SHORT-TERM EFFECTS OF ACUTE KIDNEY INJURY: THE CONVENTIONAL PERSPECTIVE 752
Electrolyte Disturbance 752
Acid-Base Disorders 753
Uremia 753
Fluid Overload 754
SHORT-TERM EFFECTS OF ACUTE KIDNEY INJURY: A NEW PERSPECTIVE 754
Acute Kidney Injury and the Innate Immune System: Proinflammatory Changes 755
Acute kidney injury and the lungs 755
Acute kidney injury and the heart 755
Acute kidney injury and the brain 755
Acute kidney injury and the gastrointestinal tract 755
Acute kidney injury and cytokine homeostasis 755
Acute Kidney Injury and the Innate Immune System: Impaired Neutrophil Function 756
Animal studies 756
Clinical studies 756
SUMMARY 757
REFERENCES 758
Long-Term Follow-up of Acute Kidney Injury 763
Key points 763
INTRODUCTION 763
DEFINING RECOVERY 764
What Is Meant by Recovery? 764
Limitations of Conventional Markers of Acute Kidney Injury 765
A Role for Alternative Markers of Acute Kidney Injury 765
ACUTE KIDNEY INJURY: WHAT ARE THE LONG-TERM RISKS? 766
ETIOLOGY OF ACUTE KIDNEY INJURY AFFECTING OUTCOME 767
CURRENT MANAGEMENT OF ACUTE KIDNEY INJURY AND AFFECT ON OUTCOME 767
IDENTIFICATION OF THE PATIENT AT ENHANCED LONG-TERM RISK 767
LONG-TERM MANAGEMENT AFTER ACUTE KIDNEY INJURY 769
SUMMARY 769
REFERENCES 770
Preventing Acute Kidney Injury 773
Key points 773
INTRODUCTION 773
INITIATIVE GOALS 774
STRATEGIES 774
Increasing Awareness of Acute Kidney Injury 775
Acute Kidney Injury and the Global Burden of Disease Study 775
Strategies for Increasing Awareness and Reducing Variations in Acute Kidney Injury Management 776
Risk: identifying high-risk individuals for primary prevention of acute kidney injury 777
Recognition: prompt diagnosis 777
Response: interventions for incipient and established acute kidney injury 779
Renal support: renal replacement therapy in acute kidney injury 779
Rehabilitation: postdischarge care of patients with acute kidney injury 780
SUMMARY 780
REFERENCES 781
Principles of Fluid Management 785
Key points 785
INTRODUCTION 785
HISTORICAL CONTEXT 786
PHASES OF FLUID THERAPY 787
Rescue 788
Optimization 788
Stabilization 788
De-escalation 789
MONITORING AND REASSESSMENT 789
TYPE OF FLUID THERAPY 789
CRYSTALLOID SOLUTIONS 791
COLLOIDS 792
QUANTITATIVE TOXICITY OF FLUID THERAPY 794
MITIGATION OF FLUID ACCUMULATION 795
SUMMARY 797
REFERENCES 797
Fluid Overload 803
Key points 803
INTRODUCTION: ASSOCIATION BETWEEN FLUID OVERLOAD AND ADVERSE OUTCOMES IN CRITICAL ILLNESS 803
DEVELOPMENT OF FLUID OVERLOAD: A PATIENT-PHYSICIAN INTERACTION 806
PATHOGENESIS OF FLUID OVERLOAD 807
MANAGEMENT OF FLUID OVERLOAD 810
Controlling Fluid Intake 810
Fluid Removal: Diuretics, Ultrafiltration, and Monitoring 811
SUMMARY 815
REFERENCES 815
Fluid Composition and Clinical Effects 823
Key points 823
INTRODUCTION 823
TYPES OF FLUIDS 824
Crystalloids 824
Unbalanced crystalloids 824
Dextrose solutions 824
0.9% Sodium chloride 824
Sodium bicarbonate solutions 824
Balanced crystalloids 824
Colloids 824
IMPORTANT PROPERTIES OF COLLOIDS 825
Molecular Weight 825
Oncotic Pressure 825
Metabolism, Elimination, and Duration of Effect 825
Carrier Fluid 825
Types of colloid 828
Human albumin solution 828
Gelatin-based colloid 828
Dextran-based colloid 829
Hydroxyethyl starch 829
PHYSIOLOGICAL EFFECTS OF DIFFERENT FLUIDS 829
Volume Expansion 829
Renal Effects 833
Hematological Effects 833
Metabolic Effects 833
Anaphylaxis 834
POTENTIAL INDICATIONS 834
0.9% Sodium Chloride 834
Bicarbonate Solutions 834
Dextrose 834
Balanced Crystalloid Solutions 834
Human Albumin Solutions 835
Hydroxyethyl Starches 835
Gelatin-Based Colloids 835
Dextrans 835
SUMMARY 835
REFERENCES 835
Renal Replacement Therapy 839
Key points 839
INTRODUCTION 839
TIMING OF INITIATION 840
VASCULAR ACCESS 842
TREATMENTS AND MODALITIES 842
DOSE 844
ANTICOAGULATION 845
SUMMARY 846
REFERENCES 846
Understanding Acid Base Disorders 849
Key points 849
INTRODUCTION 849
THE CONCEPT OF EQUILIBRIUM AND THE EVOLUTION OF THE ANALYSIS OF ACID–BASE PHYSIOLOGY 850
The Physiologic Approach and the Henderson–Hasselbalch Equation 851
Buffer Base, Base Excess, and Standard Base Excess 852
THE STEWART APPROACH 854
A Closer Look at the Strong Ion Difference 856
Weak Nonvolatile Acids 857
A NOTE ON THE STEWART MECHANISM 857
SUMMARY 858
REFERENCES 859
Index 861