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Acute Kidney Injury In Dka

G575(p)acute Kidney Injury And Diabetic Ketoacidosis; Intravenous Fluids Or Ph The Culprit? | Archives Of Disease In Childhood

G575(p)acute Kidney Injury And Diabetic Ketoacidosis; Intravenous Fluids Or Ph The Culprit? | Archives Of Disease In Childhood

G575(P) Acute kidney injury and diabetic ketoacidosis; intravenous fluids or ph the culprit? BRITISH SOCIETY FOR PAEDIATRIC ENDOCRINOLOGY AND DIABETES G575(P) Acute kidney injury and diabetic ketoacidosis; intravenous fluids or ph the culprit? 1Medical School, University of Nottingham, Nottingham, UK 2Department of Paediatric Endocrinology and Diabetes, Nottingham Childrens Hospital, Nottingham, UK Aims The aim of this study is to assess the influence of intravenous (IV) fluid regimens and blood pH on the incidence of acute kidney injury (AKI) in paediatric diabetic ketoacidosis (DKA). This is in light of recent studies raising concerns around this topic, and the 2015 update of the British Society for Paediatric Endocrinology and Diabetes (BSPED) guidelines for the management of paediatric DKA, which recommended a substantial reduction in fluid volumes given during DKA treatment. Method The following data was collected from patients under the age of 18, who were admitted to a childrens hospital with DKA from 2010 to 2018; volume of IV fluid received during admission (ml/kg/day), blood pH on admission, and the second creatinine level following admission. The sample was then divided into those who had AKI, and those who did not. AKI was defined by a second creatinine reading 1.5 times greater than the upper limit for their respective age group and gender. Results 74 patients were included in the sample, 14 of whom had AKI. The mean volume of IV fluid received in patients with AKI was 65.7 ml/kg/day, compared with 52.5 ml/kg/day in the patients without AKI. A chi-squared test was performed to explore the difference between the volume of IV fluid given (ml/kg/day) between patients with AKI and those without; a p-value of 0.078 was generated. The mean blood pH of patients w Continue reading >>

Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

Abstract Acute kidney injury is a classical complication of diabetic ketoacidosis. However, to the best of our knowledge, no study has reported the incidence and characteristics of acute kidney injury since the consensus definition was issued. Retrospective study of all cases of severe diabetic ketoacidosis hospitalised consecutively in a medical surgical tertiary ICU during 10 years. Patients were dichotomised in with AKI and without AKI on admission according to the RIFLE classification. Clinical and biological parameters were compared in these populations. Risk factors of presenting AKI on admission were searched for. Results Ninety-four patients were included in the study. According to the RIFLE criteria, 47 patients (50%) presented acute kidney injury on admission; most of them were in the risk class (51%). At 12 and 24 hours, the percentage of AKI patients decreased to 26% and 27% respectively. During the first 24 hours, 3 patients needed renal replacement therapy. Acute renal failure on admission was associated with a more advanced age, SAPS 2 and more severe biological impairments. Treatments were not different between groups except for insulin infusion. Logistic regression found 3 risk factors of presenting AKI on admission: age (odds ratio 1.060 [1.020–1.100], p<0.01), blood glucose (odds ratio 1.101 [1.039–1.166], p<0.01) and serum protein (odds ratio 0.928 [0.865–0.997], p = 0.04). Acute kidney injury is frequently associated with severe diabetic ketoacidosis on admission in ICU. Most of the time, this AKI is transient and characterised by a volume-responsiveness to fluid infusion used in DKA treatment. Age, blood glucose and serum protein are associated to the occurrence of AKI on ICU admission. Figures Citation: Orban J-C, Maizière E-M, Ghaddab A, V Continue reading >>

Diabetic Ketoacidosis Linked To Higher Risk For Aki In Youth

Diabetic Ketoacidosis Linked To Higher Risk For Aki In Youth

High rates of acute kidney injury (AKI) were reported among youth in the hospital for diabetic ketoacidosis (DKA), researchers reported. A low serum bicarbonate level (<10 mEq/L) among hospitalized children with type 1 diabetes and DKA was associated with a significant increase in the risk for stage 2 or 3 AKI (aOR 5.22; 95% CI; 1.35-20.22), according to Brenden E. Hursh, MD, of the University of British Columbia, and colleagues. In the study, published in JAMA Pediatrics, stage 1 acute kidney injury for children with DKA was also linked to an initial corrected sodium level of 145 mEq/L or more (aOR 3.29; 1.25-8.66). Using a multinomial logistic regression model, the researchers also reported a linear relationship between heart rate and severe AKI, with a 22% increase in risk for AKI associated with each increase of five beats per minute in initial heart rate (aOR 1.22; 1.07-1.39). In an interview with MedPage Today, the senior author, Constadina Panagiotopoulos, MD, also of the University of British Columbia, noted, "While I thought we would detect more cases of AKI than that previously represented by the two isolated case reports in the literature, I was surprised by the high proportion -- 64.2% -- of AKI in pediatric DKA documented in our study." The team explained that they predicted that the risk level of hospitalized children with DKA is actually higher than previous case studies have reported, and therefore aimed to identify a more accurate depiction of AKI rates for this high-risk population. Panagiotopoulos said that inspired by a lack of large-scale, systematic studies regarding AKI in youth with DKA when caring for patients affected, the researchers "decided to conduct this study to better understand the magnitude of the problem and any associated risk factor Continue reading >>

Diabetic Ketoacidosis Increases Risk Of Acute Renal Failure In Pediatric Patients With Type 1 Diabetes

Diabetic Ketoacidosis Increases Risk Of Acute Renal Failure In Pediatric Patients With Type 1 Diabetes

Condition often under-recognized, yet preventable and treatable. Diabetic ketoacidosis (DKA) is a syndrome presenting in people with diabetes when insulin utilization is markedly diminished, whether via sudden increases in insulin requirements (most often due to acute illness) or sharp decreases in exogenous insulin administration (sudden cessation, for example). DKA is manifested as severe hyperglycemia, systemic acidosis, and severe dehydration due to rapidly increasing osmotic diuresis. This condition is especially worrisome in the pediatric diabetic population, as the resulting risk of renal injury often goes unrecognized at presentation. In 2014, the results of the SEARCH for Diabetes in Youth Study suggested that approximately 30% of pediatric (<18 y.o.) type 1 diabetes patients presented with DKA at initial diagnosis. Other studies have looked at the treatment of DKA in the pediatric population, and its effects on morbidity and mortality, but until now, none have attempted to correlate DKA and acute renal failure. The current issue of JAMA Pediatric presents a study looking at the incidence of acute kidney injury in pediatric patients hospitalized for DKA and attempts to show a correlation between the two events. This retrospective review collected data on pediatric T1D patients admitted to the British Columbia Children’s Hospital with DKA between September 2008 and December 2013. Patients with the above mentioned conditions and complete medical records during that period were included. The primary objective was to determine the proportion of eligible subjects who developed acute kidney injury (AKI). During the prescribed time frame, 211 children were hospitalized at BCCH with DKA. Of these, 165 admissions met criteria for the study. Demographically, 53.9% were Continue reading >>

(pdf) Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

(pdf) Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

pital Saint-Roch, CHU de Nice, Nice, France, 2IRCAN, Faculte 3Laboratoire de Biochimie, CHU de Nice, Nice, France Acute kidney injury is a classical complication of diabetic ketoacidosis. However, to the best of our knowledge, no study has reported the incidence and characteristics of acute kidney injury since the consensus definition was issued. Retrospective study of all cases of severe diabetic ketoacidosis hospitalised consecutively in a medical surgical tertiary ICU during 10 years. Patients were dichotomised in with AKI and without AKI on admission according to the RIFLE classification. Clinical and biological parameters were compared in these populations. Risk factors of presenting AKI on Ninety-four patients were included in the study. According to the RIFLE criteria, 47 patients (50%) presented acute kidney injury on admission; most of them were in the risk class (51%). At 12 and 24 hours, the percentage of AKI patients decreased to 26% and 27% respectively. During the first 24 hours, 3 patients needed renal replacement therapy. Acute renal failure on admission was associated with a more advanced age, SAPS 2 and more severe biological impairments. Treatments were not different between groups except for insulin infusion. Logistic regression found 3 risk factors of presenting AKI on admission: age (odds ratio 1.060 [1.0201.100], p,0.01), blood glucose (odds ratio 1.101 [1.0391.166], p,0.01) and serum protein (odds ratio 0.928 [0.8650.997], p = 0.04). Acute kidney injury is frequently associated with severe diabetic ketoacidosis on admission in ICU. Most of the time, this AKI is transient and characterised by a volume-responsiveness to fluid infusion used in DKA treatment. Age, blood glucose and serum protein are associated to the occurrence of AKI on ICU admissi Continue reading >>

Acute Kidney Injury Common In Pediatric Diabetic Ketoacidosis

Acute Kidney Injury Common In Pediatric Diabetic Ketoacidosis

medwireNews: Almost two-thirds of children hospitalized with diabetic ketoacidosis (DKA) develop acute kidney injury (AKI) within 24 hours of hospitalization, study findings indicate. The most severe cases of AKI (stage 2 or 3) were significantly associated with increased volume depletion and more severe acidosis, the researchers report. “Overall, these data suggest that clinicians should consider AKI as a frequent complication that accompanies pediatric DKA and should be especially alert to its presence in severe presentations of DKA,” Constadina Panagiotopoulos (University of British Columbia, Vancouver, Canada) and co-authors write in JAMA Pediatrics. They reviewed the medical records of 165 children (median age 10.6 years) with type 1 diabetes who were hospitalized for diabetic ketoacidosis between 2008 and 2013, 75.8% of whom were newly diagnosed with type 1 diabetes during their stay. Of these, 106 (64.2%) met the Kidney Disease/Improving Global Outcomes serum creatinine criteria for AKI, of which 34.9% was stage 1, 45.3% stage 2, and 19.8% stage 3. In 99.1% of cases, AKI occurred within 24 hours of hospitalization, and it resolved with conservative fluid management by 72 hours in just over half (50.9%) of the patients. Forty patients were admitted to pediatric intensive care overall, and 85.0% of these developed AKI, compared with 57.6% of the 125 treated on a general pediatric ward. Two children required hemodialysis but none died. Panagiotopoulos and team suggest that the high rate of AKI among the children admitted to intensive care “is associated with the severe intravascular depletion inherent in more severe cases of DKA.” They add: “This theory is supported by our study findings that clinical markers of volume depletion, specifically, elevated hea Continue reading >>

Diabetic Ketoacidosis Associated With Acute Kidney Injury

Diabetic Ketoacidosis Associated With Acute Kidney Injury

A new Journal of American Medical Association article has shown that there is a high rate of occurrence of acute kidney injury (AKI) in children hospitalized with a diagnosis diabetic ketoacidosis (DKA). Acute kidney injury is one of the most common causes of renal injury that can arise from several aetiologies. Based on predisposing factors, the causes may be categorized into 3 classes: pre-renal, renal or post-renal. In cases of volume depletion, like that which occurs in diabetic ketoacidosis (a complication of diabetes where there is high ketone production), perfusion to kidneys is impaired and that is when the kidneys start to lose their functioning. Since acute kidney injury in children is associated with a poor short term and long term outcome, in a new JAMA article, and for the first time, researchers have evaluated the rate of acute kidney injury (AKI) in pediatric patients who were hospitalized for the diabetic ketoacidosis. This study was conducted at the British Columbia Children’s Hospital from 2008 through 2013. 165 children aged 18 years or younger with type 1 diabetes, DKA and with complete medical records available for data analysis were included. The primary outcome was the development of acute kidney injury defined using Kidney Disease/Improving Global Outcomes serum creatinine criteria. As per findings, in the designed timeframe, of the 165 children hospitalized for DKA, 106 (64.2%) developed AKI.Two children required hemodialysis. Statistical analysis has shown that a serum bicarbonate level of less than 10 mEq/L was associated with a 5-fold increased risk of developing severe kidney injury. This means that the incidence of acute kidney injury is directly associated with the severity of the acidosis resulting from DKA. Increase in heart rate (demo Continue reading >>

Acute Kidney Injury As A Severe Complication Of Diabetic Ketoacidosis

Acute Kidney Injury As A Severe Complication Of Diabetic Ketoacidosis

Background: Diabetic ketoacidosis (DKA) in children and young adults carries significant morbidity and mortality relating to complications such as cerebral oedema. Acute kidney injury (AKI) is a rare but potentially fatal complication of DKA. We present three cases of DKA complicated by AKI. Case 1: A 9-year-old girl presented with severe DKA at diagnosis. She was treated with intravenous fluids and insulin as per protocol. She had oliguria and haematuria 36 h after admission. She was hypertensive with evidence of enlarged kidneys on ultrasound (USS). She was transferred to the renal unit where she needed two cycles of hemodialysis before making full recovery. Case 2: A 14-year-old girl presented with severe DKA and altered consciousness at diagnosis. She developed oliguria 24 h after starting treatment for DKA. USS of abdomen showed enlarged kidneys. Her renal function improved with haemofiltration and recovered fully by 1 week. Case 3: 17-year-old girl with poorly controlled type 1 diabetes presented with severe DKA. She showed evidence of AKI with very high plasma creatinine, oliguria and low plasma phosphate. She was managed conservatively with individualised fluid plan and phosphate supplementation with recovery in 7 days. Conclusion: Patients with severe DKA can develop AKI due to a number of possible causes, hypovolaemia being the most likely primary cause. Appropriate management of hypovolemia and electrolyte disturbance in these patients can be very challenging. These cases highlight the importance of early recognition of AKI (rising plasma creatinine, oliguria, haematuria) and discussion with paediatric nephrologist to formulate individualised fluid therapy in order to prevent deterioration in renal function. It is uncertain if recent modification in fluid man Continue reading >>

High Rate Of Aki In Children With Diabetic Ketoacidosis

High Rate Of Aki In Children With Diabetic Ketoacidosis

Kidney News Findings High Rate of AKI in Children with Diabetic Ketoacidosis High Rate of AKI in Children with Diabetic Ketoacidosis Nearly two-thirds of children with type 1 diabetes hospitalized for diabetic ketoacidosis (DKA) will develop acute kidney injury (AKI), suggests a study in JAMA Pediatrics. The researchers reviewed all DKA admissions at a Canadian childrens hospital from 2008 to 2013. Complete medical records were available for 165 patients. The median age was 10.6 years; 54% were female. Three-fourths of patients were newly diagnosed with type 1 diabetes. Fifty-five percent were transferred from another hospital and nearly one-fourth were admitted to the ICU. Median initial pH was 7.1 and serum bicarbonate level 7.0 mEq/L. Based on Kidney Disease/Improving Global Outcomes criteria, 64.2% of patients developed AKI while in the hospital. Of affected children, 34.9% had AKI stage 1, 45.3% had AKI stage 2, and 19.8% had AKI stage 3. Two patients required hemodialysis. On adjusted analysis, factors associated with the development of stage 2 or 3 AKI were serum bicarbonate less than 10 mEq/L, adjusted odds ratio (OR) 5.22; and higher initial heart rate, OR 1.22 per increase of 5 beats/min. Odds of stage 1 AKI were increased for children with an initial corrected sodium level of 145 mEq/L or greater, OR 3.29. There were no deaths in children with or without AKI. The study documents a high prevalence of AKI among children with DKA admitted to a tertiary care childrens hospital. This risk appears higher in children with laboratory evidence of volume depletion and severe acidosis. The authors call for prospective studies to clarify the risk factors and long-term implications of AKI in pediatric DKAa group of young patients who already have a high long-term risk of Continue reading >>

Acute Kidney Injury As A Severe Complication Of Diabetic Ketoacidosis

Acute Kidney Injury As A Severe Complication Of Diabetic Ketoacidosis

Endocrine Abstracts (2015) 39 EP55 | DOI: 10.1530/endoabs.39.EP55 Acute kidney injury as a severe complication of diabetic ketoacidosis Alagusutha Jeyaraman1, Verghese Mathew1, Eric Finlay2 & Sanjay Gupta1 Author affiliations View ePoster Download ePoster 1Hull Royal Infirmary, Hull, UK; 2General Infirmary, Leeds, UK. Background: Diabetic ketoacidosis (DKA) in children and young adults carries significant morbidity and mortality relating to complications such as cerebral oedema. Acute kidney injury (AKI) is a rare but potentially fatal complication of DKA. We present three cases of DKA complicated by AKI. Case 1: A 9-year-old girl presented with severe DKA at diagnosis. She was treated with intravenous fluids and insulin as per protocol. She had oliguria and haematuria 36 h after admission. She was hypertensive with evidence of enlarged kidneys on ultrasound (USS). She was transferred to the renal unit where she needed two cycles of hemodialysis before making full recovery. Case 2: A 14-year-old girl presented with severe DKA and altered consciousness at diagnosis. She developed oliguria 24 h after starting treatment for DKA. USS of abdomen showed enlarged kidneys. Her renal function improved with haemofiltration and recovered fully by 1 week. Case 3: 17-year-old girl with poorly controlled type 1 diabetes presented with severe DKA. She showed evidence of AKI with very high plasma creatinine, oliguria and low plasma phosphate. She was managed conservatively with individualised fluid plan and phosphate supplementation with recovery in 7 days. Conclusion: Patients with severe DKA can develop AKI due to a number of possible causes, hypovolaemia being the most likely primary cause. Appropriate management of hypovolemia and electrolyte disturbance in these patients can be v Continue reading >>

Rhabdomyolysis-induced Acute Kidney Injury In Diabetic Emergency: Underdiagnosed And An Important Association To Be Aware Of

Rhabdomyolysis-induced Acute Kidney Injury In Diabetic Emergency: Underdiagnosed And An Important Association To Be Aware Of

Volume 2018 |Article ID 4132738 | 3 pages | Rhabdomyolysis-Induced Acute Kidney Injury in Diabetic Emergency: Underdiagnosed and an Important Association to Be Aware of ,1 Bhavika Gandhi,1 Steven Torre,1 Alireza Amirpour,1 Jennifer Cheng,2 Mayurkumar Patel,1 and Mohammad A. Hossain1 1Department of Medicine, Internal Medicine Residency Program, Hackensack Meridian Health, Jersey Shore University Medical Center, Neptune, New Jersey 07753, USA 2Endocrine Service, Nephrology Service, Hackensack Meridian Health Cancer Care, Jersey Shore University Medical Center, Neptune, New Jersey 07753, USA Rhabdomyolysis is a potentially life-threatening clinical syndrome associated with muscle injury which can cause a leakage of intracellular contents, manifested from the range of being asymptomatic to a life-threatening condition causing acute kidney injury and severe electrolyte abnormalities. Rhabdomyolysis has been associated with both diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome, though there is an increased association with rhabdomyolysis and acute kidney injury with hyperosmolar nonketonic state compared with patients with diabetic ketoacidosis. Common clinical manifestations are muscle pain, dark urine, and generalized weakness. The causes of rhabdomyolysis are broadly categorized into three groups: traumatic, nontraumatic exertional, and nontraumatic nonexertional. Here, we present a case of rhabdomyolysis-induced acute kidney injury in a patient with hyperosmolar hyperglycemic state. The patient was discharged on insulin and needed intermittent dialysis for two months. Our case highlights the importance of the rare association of rhabdomyolysis causing acute kidney injury in a diabetic emergency. Rhabdomyolysis is a syndrome caused by muscle Continue reading >>

Original Article Clinical Outcomes Of Septic Patients With Diabetic Ketoacidosis Between 2004 And 2013 In A Tertiary Hospital In Taiwan

Original Article Clinical Outcomes Of Septic Patients With Diabetic Ketoacidosis Between 2004 And 2013 In A Tertiary Hospital In Taiwan

Infection is the most common predisposing factor for diabetic ketoacidosis (DKA); however, studies are rare that have investigated the clinical outcomes of septic patients with infection-precipitated DKA. A retrospective cohort study was conducted at a tertiary hospital from 2004 to 2013. Patients with DKA in whom the presence of a predisposing infection was confirmed were enrolled. Characteristics at initial presentation, primary infection sources, and causative microorganisms were compared between the nonacute kidney injury (non-AKI) group and acute kidney injury (AKI) group at each stage. Risk factors for the development of failure-stage AKI and its outcomes were also analyzed. One hundred and sixty DKA episodes were assessed. The most common infection sites were the urinary and respiratory tracts. The leading causative microorganism was Escherichia coli, followed by Klebsiella pneumoniae. A complicated/severe infection state [odds ratio (OR), 15.27; p < 0.001] and a high level of C-reactive protein (OR, 1.012; p < 0.001) were independently associated with bacteremia. Corrected sodium (Na; OR, 1.062; p = 0.039), initial plasma glucose (OR, 1.003; p = 0.041), severe grade of DKA (OR, 13.41; p = 0.045), and the Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR, 1.08; p = 0.033) were identified as independent risk factors for the development of failure-stage AKI among septic patients with infection-precipitated DKA. Patients with failure-stage AKI had a higher frequency of incomplete recovery of renal function (20.4% of patients in failure vs. 5.9% of patients in risk and injury, p = 0.009). Bacteremia independently predicted the absence of complete recovery of renal function (OR, 5.86; p = 0.038). For patients with infection-precipitated DKA, the cli Continue reading >>

Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

Incidence And Characteristics Of Acute Kidney Injury In Severe Diabetic Ketoacidosis

Go to: Introduction The incidence of diabetes mellitus is increasing worldwide affecting both types of the disease. The most frequent acute diabetic complications are hyperglycemic crises, namely diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state. Diabetic ketoacidosis results from an absolute insulin deficiency. Classical presentation associates a triad of uncontrolled hyperglycemia, metabolic acidosis and high ketone bodies concentration. Similarly to diabetes, the incidence of DKA increases over time [1], [2]. This may be a life-threatening condition due to severe clinical and biological impairments and treatment associated complications (cerebral edema, acute respiratory distress syndrome, hypokalaemia, hypophosphatemia). However, mortality is low and most of the time, death is related to the precipitating factor [3]–[6]. For this reason, admission of these patients in ICU is still debated. A grading system for severity of DKA was described previously [7]. Patients presenting the most severe grades or common severity criteria were considered for ICU admission. However this grading system is not recommended for clinical practice, resulting in wide variations in ICU utilisation for DKA, depending on the national practices, the number of DKA admitted in the units and the severity of the clinical status [8]. Interestingly, in the absence of randomised trials, there are no data showing any impact of the level of care on DKA mortality. To help clinicians, guidelines for DKA management are published and updated by the American Diabetic Association [6]. Their effect on clinical outcome is unclear as compliance to guidelines is poor in diabetes care and ICU [9], [10]. However, implementation of a local mandatory protocol seems more efficient to decrease ICU a Continue reading >>

Severe Diabetic Ketoacidosis – A Remarkable Case Study

Severe Diabetic Ketoacidosis – A Remarkable Case Study

Summarized from Van de Vyver C, Damen J, Haentjens C et al. An exceptional case of diabetic ketoacidosis. Case Reports in Emergency Medicine 2017. Diabetic ketoacidosis (DKA) is a potentially life-threatening acute complication of type 1 diabetes caused by insulin deficiency. It is characterized by raised blood glucose (hyperglycemia), metabolic acidosis, and increased blood/urine ketones. Dehydration and electrolyte disturbance are common and affected patients may develop some degree of acute kidney injury (AKI) consequent on fluid loss (hypovolemia) due to osmotic diuresis associated with severe hyperglycemia. DKA evolves rapidly over a short time frame (hours rather than days) and can occur (rarely) in those with type 2 diabetes. This DKA case study is particularly noteworthy because of the severity of the hyperglycemia and acid-base disturbance, and the fact that the patient survived such profound metabolic disturbance and associated life-threatening hemodynamic changes. The case concerns a 33-year-old woman with ”brittle” type 1 diabetes treated with continuous subcutaneous insulin infusion (insulin pump). She had, in common with many brittle diabetics, a history of gastroparesis (delayed stomach emptying). Some 36 hours prior to emergency hospital admission she complained of abdominal pain and vomiting after attending a party. Her condition deteriorated before transfer to hospital. The ambulance team reported a rapid decline in Glasgow Coma Score (GCS) from 13 to 3 in only 10 minutes, sinus tachycardia, undetectable peripheral pulse, and hypotension (BP 99/52 mmHg). Clinical examination revealed severe dehydration and respiratory distress (respiration rate 40 breaths/min). Urgent intubation was necessary and systolic blood pressure dropped further to 55 mmHg. Continue reading >>

Overview Of The Management Of Acute Kidney Injury In Adults

Overview Of The Management Of Acute Kidney Injury In Adults

INTRODUCTION Acute kidney injury (AKI) is an abrupt and usually reversible decline in the glomerular filtration rate (GFR). This results in an elevation of serum blood urea nitrogen (BUN), creatinine, and other metabolic waste products that are normally excreted by the kidney. The term AKI, rather than acute renal failure (ARF), is increasingly used by the nephrology community to refer to the acute loss of kidney function. This term also highlights that injury to the kidney that does not result in "failure" is also of great clinical significance. In this topic review, the acute loss of kidney function will be referred to as AKI. The initial assessment of patients with AKI and management of the major complications of AKI are discussed here. The incidence, causes, diagnosis, and prevention of AKI are presented separately. (See "Diagnostic approach to adult patients with subacute kidney injury in an outpatient setting" and "Kidney and patient outcomes after acute kidney injury in adults" and "Possible prevention and therapy of ischemic acute tubular necrosis".) PATHOGENESIS AKI has multiple possible etiologies. Among hospitalized patients, AKI is most commonly due to either prerenal etiologies (volume depletion, "third spacing," effective volume depletion from heart failure or cirrhosis) or acute tubular necrosis (ATN) from ischemia, nephrotoxin exposure, or sepsis [1]. The pathogenesis of ATN is discussed elsewhere. (See "Pathogenesis and etiology of ischemic acute tubular necrosis" and "Pathogenesis, clinical features, and diagnosis of contrast-induced nephropathy".) Other frequent causes of AKI among either ambulatory or hospitalized patients include volume depletion, urinary obstruction, rapidly progressive glomerulonephritis, and acute interstitial nephritis. The path Continue reading >>

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