Prevention of Acute Renal Failure Role of vasoactive drugs and diuretic agents
|
|
- Ross Ford
- 5 years ago
- Views:
Transcription
1 of Acute Renal Failure Role of vasoactive drugs and diuretic agents Armand R.J. Girbes Prof.dr. A.R.J. Girbes Chairman department of Intensive Care VU University Medical Center Netherlands
2 (Failure of) Renal function Acid-base control Renin production Erythropoietin production Control of electrolyte balance Excretion of (metabolized) drugs Measurable Urine production Excretion Nitrogen waste products Definition ARF No consensus
3 Definition Acute & sustained increase in screat > 44 microm/l (baseline Creat < 221microM/l) > 20% rise (baseline Creat > 221 microm/l) Oliguria < 0.5 ml/kg/min (sustained)
4 Definition RIFLE classification Three severity categories
5 Incidence (depends on definition & case mix) 1 25% in ICU patients Mostly part of MODS Always bad news for the ICU patient Mortality increases ± twofold Metnitz, CCM 2002
6 Based on Knowledge of pathophysiology Rational thinking Animal experiments Evidence Based Medicine RCT Major causes Pre-Renal Renal Post-Renal
7
8 Acute tubular necrosis {=AKI Acute Kidney Injury} Ischemia ~ systemic hypotension ~ intrarenal vasoconstriction ~ fall in RBF Local (tubular) damage ~ inflammatory cells & cytokines Oxygen radicals ~ intraglomerular thrombosis ~ tubular obstruction ~ tubular back leak
9 Predisposition risk factors Diabetic nephropathy Preexisting renal function loss High age CHF ARF in previous history Low effective circulating volume
10 Recognize risks surveillance armée Avoid harm Treat
11 Just too late Acute Renal Failure
12 Too late
13 Real prevention - avoid
14 Acknowledge physiology Kidney needs blood flow Kidney needs perfusion pressure
15 Vasoactive drugs and fluids Maintenance of RBF and perfusion pressure Maintain optimal haemodynamics Optimal??
16 Optimal systemic haemodynamics? Optimal filling Further filling no further increase CO Start early In sepsis: SvO2 > 70% lower mortality/organ dysfunction Sufficient perfusion pressure Failure dopamine start NE diuresis Rivers et al Martin et al Girbes & Groeneveld 2000
17 Norepinephrine (after optimal fluid resuscitation) Does not deteriorate renal function Can improve renal function GFR Diuresis No RCT available ml/min/1.73 m 2 GFR 160 * noradrenaline in ng/kg/min
18 Regional haemodynamics Dopamine Pre- and preferential postglomerular vasodilatation RBF GFR Girbes et al. 1991, 1992, 1996, 2004
19 Dopamine renal haemodynamics Simplification Dopamine does not increase medullary oxygenation Dopamine does not increase RBF in all patients Low GFR Post surgery Tachyfylaxia receptor down regulation Danger!!! Dopamine is a diuretic Other side effects
20 First author Patient Group DOPAMINE routine administration Endpoint Conclusion Costa, 1990 CABG CreatCx No difference Swygert, 199l LiverTx GFR, dialysis No difference Myles, 1991 Post cardiac surgery screat, CreatCx No difference Baldwin, 1994 Major vascular surgery screat, CreatCx No difference Parks, 1994 Obstructive Jaundice screat, CreatCx No difference Kadieva,1993 RenalTx screat, Biopsy (tub.necr.) No difference Chertow, 1996 Acute renal failure mortality, dialysis No difference ANZIS, 2000 Early renal dysfunction GFR/sCreat No difference Lassnigg, 2000 Cardiac surgery patients screat No difference Carcoana, 2003 Cardiac surgery patients Beta-2 microglobulin excr Dopamine increases B2M Gatot, 2004 Cardiac surgery patients Creat and stability Dopamine better
21 Dopamine
22 Dopamine Effect on mortality
23 Dopamine Effect on need for CRRT
24 Dopamine Effect on diuresis day 1
25 Clinical trials low-dose dopamine No benefit of - preventive - dopamine
26 Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomized trial ANZICS clinical trials group Lancet 2000; 356:
27 n = µg/kg/min dopamine vs placebo Inclusion criteria age > 18 years 2 signs of SIRS early renal dysfunction < 0.5 ml/kg/hr in 4 hours OR rise screat > 80 µm/l Lancet, 2000
28 dopamine (n=161) placebo (n=163) Age 63 ± ± 17 M/F 94/67 102/61 APACHE II 21 ± 6 21 ± 8 Shock at start infusion On ventilator at start Prerenal dysfunction Baseline creatinine 183 ± ± 81 Oliguria MAP 80 ± ± 16 CVP 14 ± 8 13 ± 7 Lancet, 2000
29 Primary endpoint peak serum creatinine concentration Secondary endpoints duration mechanical ventilation ICU stay / hospital stay survival Lancet, 2000
30 dopamine placebo Peak creatinine 245 ± ± 147 Increase in creatinine 62 ± ± 108 Creatinine > 300 µm/l n=56 n=56 CRRT n=35 n=40 Urine output (ml/hr) baseline 37 ± ± 59 after 1 h 71 ± ± 77 after 24 h 96 ± ± 72 after 48 h 99 ± ± 95 Lancet, 2000
31 Subgroup analysis time to recovery of normal renal function Lancet, 2000
32 ANZICS Not purely on prevention Renal function loss already started
33 Diuretic agents Rationale Inhibit oxygen consuming processes TranscellularNa + transport Cortical vasodilatation (loop diuretics) Reduce intratubular obstruction & back leak of filtrate
34 Diuretics possible drawbacks & pitfalls Masks hypovolemia Neurohumoral activation increase of SVR Maldistribution of RBF diversion of medullary perfusion tubular dysfunction
35
36 Lassnigg et al. RCT Acute Renal Failure Elective cardiac surgery n=123 Serum creatinine < 2.0 mg/dl dopamine n=42 frusemide n=41 placebo n= mg/50 50 mg/50 NaCl 0.9% 2 mcg/kg/min 0.5 mcg/kg/min
37 Demographic Acute Renal Failure Lassnigg et al. 2000
38 Lassnigg et al. Acute Renal Failure Dopa n=42 Placebo n=40 Frusemide n=41
39 Conclusion Dopamine: no benefit Acute Renal Failure Frusemide: increases risk for renal impairment
40
41
42 Mannitol Acute Renal Failure Osmotic diuretic Free radical scavenger Transient increase of circulating volume Augmenting RBF flushes the tubules No clinical studies proof Rhabdomyolysis
43 Acetylcysteïne Acute Renal Failure Conflicting results Recent favorable results in large study primary angioplasty (Marenzi et al. NEJM, 2006) Meta-analyses suggest benefit for contrast nephropathy (Birck et al. Lancet, 2003) Favorable efficacy versus side effects profile Off-pump cardiac surgery Sajja et al. J Thorac & Cardiovasc Surg Feb 2007 N=116 Suggests favorable (short-term) effect
44 Fenoldopam Acute Renal Failure Selective DA1 agonist Induces renal vasodilation Indication: severe hypertension Girbes et al. 1991, Murphy et al. 2001
45 ARF prevention Fenoldopam
46 Final conclusions Acute Renal Failure Good intensive care medicine Fluid resuscitation Flow & pressure Diuretics Do not exclude NE May be harmful Dopamine Do not use as prophylactic Anticipate!! E.g. rhabdomyolysis, acute interstitial nephritis Use acetylcystein for prevention of contrast nephropathy
47 of Acute Renal Failure There are no magic bullets Just high quality anesthesia & intensive care Do basic things well
48 Thank you! Presentation available at: (after the congress)
Acute Kidney Injury for the General Surgeon
Acute Kidney Injury for the General Surgeon UCSF Postgraduate Course in General Surgery Maui, HI March 20, 2011 Epidemiology & Definition Pathophysiology Clinical Studies Management Summary Hobart W. Harris,
More informationAcute Liver Failure: Supporting Other Organs
Acute Liver Failure: Supporting Other Organs Michael A. Gropper, MD, PhD Professor of Anesthesia and Physiology Director, Critical Care Medicine University of California San Francisco Acute Liver Failure
More informationWhen and how to start RRT in critically ill patients? Intensive Care Training Program Radboud University Medical Centre Nijmegen
When and how to start RRT in critically ill patients? Intensive Care Training Program Radboud University Medical Centre Nijmegen Case history (1) 64 Hypertension 2004 AVR 2009 Paravalvular leak - dilated
More informationAcute Kidney Injury. Amandeep Khurana, MD Southwest Kidney Institute
Acute Kidney Injury Amandeep Khurana, MD Southwest Kidney Institute 66 yr white male w/ DM, HTN, CAD admitted to an OSH w/ E Coli UTI on 7/24/16, developed E Coli bacteremia and Shock (on vaso + levo)
More informationSeptic Acute Kidney Injury (AKI) Rinaldo Bellomo Australian and New Zealand Intensive Care Research Centre (ANZIC-RC) Melbourne Australia
Septic Acute Kidney Injury (AKI) Rinaldo Bellomo Australian and New Zealand Intensive Care Research Centre (ANZIC-RC) Melbourne Australia Things we really, honestly know about septic AKI AKI is common
More informationOBJECTVES OF LEARNING
OBJECTVES OF LEARNING ACUTE RENAL FAILURE AND RENAL REPLACEMENT THERAPY DR.TAI CHENG SHENG RECOGNITION OF DEFINITION OF ARF RECOGNITION OF CAUSE OF ARF RECOGNITION OF PATHOGENESIS OF ARF RECOGNITION OF
More informationFluid Resuscitation in Critically Ill Patients with Acute Kidney Injury (AKI)
Fluid Resuscitation in Critically Ill Patients with Acute Kidney Injury (AKI) Robert W. Schrier, MD University of Colorado School of Medicine Denver, Colorado USA Prevalence of acute renal failure in Intensive
More informationFailure of the circulation to maintain Tissue cellular. Tissue hypoperfusion Cellular hypoxia SHOCK. Perfusion
Shock SHOCK Failure of the circulation to maintain Tissue cellular Perfusion Organs Syndrome RR
More informationUpdate in Critical Care Medicine
Update in Critical Care Medicine Michael A. Gropper, MD, PhD Professor and Executive Vice Chair Department of Anesthesia and Perioperative Care Director, Critical Care Medicine UCSF Disclosure None Update
More informationDr.Nahid Osman Ahmed 1
1 ILOS By the end of the lecture you should be able to Identify : Functions of the kidney and nephrons Signs and symptoms of AKI Risk factors to AKI Treatment alternatives 2 Acute kidney injury (AKI),
More informationContrast Induced Nephropathy
Contrast Induced Nephropathy O CIAKI refers to an abrupt deterioration in renal function associated with the administration of iodinated contrast media O CIAKI is characterized by an acute (within 48 hours)
More informationPROTECTING THE KIDNEYS FROM PERIOPERATIVE ISCHEMIA. Connie Lynne Lorette, PhD, CRNA Northeastern University Boston MA
PROTECTING THE KIDNEYS FROM PERIOPERATIVE ISCHEMIA Connie Lynne Lorette, PhD, CRNA Northeastern University Boston MA Key Points Pathophysiology and diagnostic criteria for perioperative renal failure Risk
More informationEvidence-Based. Management of Severe Sepsis. What is the BP Target?
Evidence-Based Management of Severe Sepsis Michael A. Gropper, MD, PhD Professor and Vice Chair of Anesthesia Director, Critical Care Medicine Chair, Quality Improvment University of California San Francisco
More informationAcute Kidney Injury in the ED
+ Acute Kidney Injury in the ED + Dr Eric Clark, MD FRCPC University of Ottawa Canada Canadian Association of Emergency Physicians + Outline 1. Diagnostic challenges 2. ED treatment 3. Contrast induced
More informationAcute Kidney Injury. Arvind Bagga All India Institute of Medical Sciences New Delhi, India
Acute Kidney Injury Arvind Bagga All India Institute of Medical Sciences New Delhi, India What is AKI? Sudden loss of renal function, over hrdays, with derangement(s) in fluid balance, acid base & electrolytes
More informationVasopressors in Septic Shock. Keith R. Walley, MD St. Paul s Hospital University of British Columbia Vancouver, Canada
Vasopressors in Septic Shock Keith R. Walley, MD St. Paul s Hospital University of British Columbia Vancouver, Canada Echocardiogram: EF=25% 57 y.o. female, pneumonia, shock Echocardiogram: EF=25% 57 y.o.
More informationTHE KIDNEY IN HYPOTENSIVE STATES. Benita S. Padilla, M.D.
THE KIDNEY IN HYPOTENSIVE STATES Benita S. Padilla, M.D. Objectives To discuss what happens when the kidney encounters low perfusion To discuss new developments and clinical application points in two scenarios
More informationJMSCR Vol 06 Issue 12 Page December 2018
www.jmscr.igmpublication.org Impact Factor (SJIF): 6.379 Index Copernicus Value: 79.54 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v6i12.02 Original Research Article Fractional
More informationAKI: definitions, detection & pitfalls. Jon Murray
AKI: definitions, detection & pitfalls Jon Murray Previous conventional definition Acute renal failure (ARF) An abrupt and sustained decline in renal excretory function due to a reduction in glomerular
More informationRENAL PHYSIOLOGY. Zekeriyya ALANOGLU, MD, DESA Ahmet Onat Bermede, MD, Ankara University School of Medicine Dept. Anesthesiology and ICM
RENAL PHYSIOLOGY Zekeriyya ALANOGLU, MD, DESA Ahmet Onat Bermede, MD, Ankara University School of Medicine Dept. Anesthesiology and ICM Kidneys Stabilize the composition of the ECF (electrolyte, H
More informationContrast-Induced Nephropathy: Evidenced Based Prevention
Contrast-Induced Nephropathy: Evidenced Based Prevention Michael J Cowley, MD, FSCAI Nothing to disclose Contrast-Induced Nephropathy (CIN) Definitions New onset or worsening of renal function after contrast
More informationAcute Kidney Injury; get the basics right first!
Acute Kidney Injury; get the basics right first! Dr Christopher Wong, Consultant Nephrologist and General Physician, University Hospital Aintree (UHA), Liverpool, UK Acute kidney injury (AKI) Why a new
More informationFluids in Sepsis: How much and what type? John Fowler, MD, FACEP Kent Hospital, İzmir Eisenhower Medical Center, USA American Hospital Dubai, UAE
Fluids in Sepsis: How much and what type? John Fowler, MD, FACEP Kent Hospital, İzmir Eisenhower Medical Center, USA American Hospital Dubai, UAE In critically ill patients: too little fluid Low preload,
More informationRENAL PHYSIOLOGY. Zekeriyya ALANOGLU, MD, DESA. Ahmet Onat Bermede, MD. Ankara University School of Medicine Dept. Anesthesiology and ICM
RENAL PHYSIOLOGY Zekeriyya ALANOGLU, MD, DESA. Ahmet Onat Bermede, MD. Ankara University School of Medicine Dept. Anesthesiology and ICM Kidneys Stabilize the composition of the ECF (electrolyte,
More informationECMO & Renal Failure Epidemeology Renal failure & effect on out come
ECMO Induced Renal Issues Transient renal dysfunction Improvement in renal function ECMO & Renal Failure Epidemeology Renal failure & effect on out come With or Without RRT Renal replacement Therapy Utilizes
More informationClinical Significance of ARF. Hospital Acquired Renal Insufficiency. Case - Acute Renal Failure. Hospital Acquired Renal Insufficiency
Case - Acute Renal Failure 73 yo diabetic F w hx of mild HBP but normal renal function develops infection of R foot. Over 1 week fever, chills, inflammation swelling of her R foot and leg. She takes Motrin
More informationAcute Kidney Injury (AKI) How Wise is Early Dialysis in Critically Ill Patients? Modalities of Dialysis
Acute Kidney Injury (AKI) How Wise is Early Dialysis in Critically Ill Patients? A common condition in ICU patients Associated with high mortality and morbidity Renal Replacement Therapy (RRT) is the cornerstone
More informationInitial approach to ascites
Ascites: Filling and Draining the Water Balloon Common Pathogenesis in Refractory Ascites, Hyponatremia, and Cirrhosis intrahepatic resistance sinusoidal portal hypertension Splanchnic vasodilation (effective
More informationWEEK. MPharm Programme. Acute Kidney Injury. Alan M. Green MPHM13: Acute Kidney Injury. Slide 1 of 47
MPharm Programme Acute Kidney Injury Alan M. Green 2017 Slide 1 of 47 Overview Renal Function What is it? Why does it matter? What causes it? Who is at risk? What can we (Pharmacists) do? How do you recognise
More informationSeptic AKI in ICU patients
Septic AKI in ICU patients Prof. Achim Jörres, M.D. Dept. of Nephrology and Medical Intensive Care Charité University Hospital Campus Virchow Klinikum Berlin, Germany achim.joerres@charite.de Agenda Epidemiology
More informationAcute Kidney Injury. I. David Weiner, M.D. Division of Nephrology, Hypertension and Transplantation University of Florida and NF/SGVHS
Acute Kidney Injury I. David Weiner, M.D. Division of Nephrology, Hypertension and Transplantation University of Florida and NF/SGVHS 374-6102 David.Weiner@medicine.ufl.edu www.renallectures.com Concentration
More informationDoreen P. Foley MS RN ANP-C Doctor of Nursing Practice Program Chamberlain College of Nursing
Doreen P. Foley MS RN ANP-C Doctor of Nursing Practice Program Chamberlain College of Nursing This program has been developed solely for the purposes of describing the level of nurse practitioner (NP)
More informationKidney dysfunction. Copotoiu SMa
Kidney dysfunction Copotoiu SMa Functions of the kidneys Water and electrolyte homeostasis Excretion in the urine of waste products of metabolism Excretion of chemicals/drugs Hormone production: renin,
More informationHepatorenal Syndrome
Necker Seminars in Nephrology Institut Pasteur Paris, April 22, 2013 Hepatorenal Syndrome Dr. Richard Moreau 1 INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, 2 Université Paris Diderot
More informationRenal failure in sepsis and septic shock
Renal failure in sepsis and septic shock Dr. Venugopal Reddy. MD, EDIC, FCARCSI Associate Professor of Anesthesiology and Critical Care medicine Department of Anaesthesia and CCM Penn State College of
More informationBlood purification in sepsis
Blood purification in sepsis Joannes-Boyau O Dept of anesthesiology and intensive care, University Hospital of Bordeaux, France 1 Types of Blood Purification hemofilters regular pore size (MW < 40,000D)
More informationFluid balance and clinically relevant outcomes
Fluid balance and clinically relevant outcomes Rui Moreno, MD, PhD, Professor UCINC, Hospital de São José Centro Hospitalar de Lisboa Central, E.P.E. INSULT PRIMARY MODS SIRS SECONDARY MODS OUTCOME RECOVERY
More informationAcute Kidney Injury after Cardiac Surgery: Incidence, Risk Factors and Prevention
Acute Kidney Injury after Cardiac Surgery: Incidence, Risk Factors and Prevention Hong Liu, MD Professor of Clinical Anesthesiology Department of Anesthesiology and Pain Medicine University of California
More informationObjectives. Epidemiology of Sepsis. Review Guidelines for Resuscitation. Tx: EGDT, timing/choice of abx, activated
Update on Surviving Sepsis 2008 Objectives Epidemiology of Sepsis Definition of Sepsis and Septic Shock Review Guidelines for Resuscitation Dx: Lactate, t cultures, SVO2 Tx: EGDT, timing/choice of abx,
More informationVasoactive Medications. Matthew J. Korobey Pharm.D., BCCCP Critical Care Clinical Specialist Mercy St. Louis
Vasoactive Medications Matthew J. Korobey Pharm.D., BCCCP Critical Care Clinical Specialist Mercy St. Louis Objectives List components of physiology involved in blood pressure Review terminology related
More informationAcute Kidney Injury. APSN JSN CME for Nephrology Trainees May Professor Robert Walker
Acute Kidney Injury APSN JSN CME for Nephrology Trainees May 2017 Professor Robert Walker Kidney International (2017) 91, 1033 1046; http://dx.doi.org/10.1016/ j.kint.2016.09.051 Case for discussion 55year
More informationACUTE KIDNEY INJURY. Stuart Linas U. Colorado SOM
ACUTE KIDNEY INJURY Stuart Linas U. Colorado SOM Marked increases in incidence of dialysis-requiring AKI in last decade JASN 24 37 2013 Question 1 Of patients who recover from an episode of AKI, what percentage
More informationProceedings of the 34th World Small Animal Veterinary Congress WSAVA 2009
www.ivis.org Proceedings of the 34th World Small Animal Veterinary Congress WSAVA 2009 São Paulo, Brazil - 2009 Next WSAVA Congress : Reprinted in IVIS with the permission of the Congress Organizers HOW
More informationSurviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 Mitchell M. Levy MD, MCCM Professor of Medicine Chief, Division of Pulmonary, Sleep, and Critical Care
More informationSAFETY IN THE CATH LAB How to Minimise Contrast Toxicity
SAFETY IN THE CATH LAB How to Minimise Contrast Toxicity Dr. Vijay Kunadian MBBS, MD, MRCP Senior Lecturer and Consultant Interventional Cardiologist Institute of Cellular Medicine, Faculty of Medical
More informationAcute kidney injury definition, causes and pathophysiology. Financial Disclosure. Some History Trivia. Key Points. What is AKI
Acute kidney injury definition, causes and pathophysiology Financial Disclosure Current support: Center for Sepsis and Critical Illness Award P50 GM-111152 from the National Institute of General Medical
More informationPrevention of Contrast induced Nephropathy
55 th Annual Scientific Meeting of The Korean Society of Cardiology 11:50 12:10 Message from Nephrologists Dec 03, 2011 Prevention of Contrast induced Nephropathy Soo Wan Kim, MD, PhD Department of Internal
More informationDialyzing challenging patients: Patients with hepato-renal conditions
Dialyzing challenging patients: Patients with hepato-renal conditions Nidyanandh Vadivel MD Medical Director for Living kidney Donor and Pancreas Transplant Programs Swedish Organ Transplant, Seattle Acute
More informationAcute Kidney Injury in Trauma. David Lee Skinner MBChB FCS(SA) Trauma Unit Inkosi Albert Luthuli Central Hospital KwaZulu Natal South Africa
Acute Kidney Injury in Trauma David Lee Skinner MBChB FCS(SA) Trauma Unit Inkosi Albert Luthuli Central Hospital KwaZulu Natal South Africa Acute Kidney Injury Acute Renal Failure RIFLE & AKIN RIFLE criteria
More informationRationale for renal replacement therapy in ICU: indications, approaches and outcomes. Richard Beale
Rationale for renal replacement therapy in ICU: indications, approaches and outcomes Richard Beale RIFLE classification (ADQI group) 2004 Outcome AKIN classification Definition: Abrupt (within 48 hrs)
More informationThe Cardiorenal Syndrome in Heart Failure
The Cardiorenal Syndrome in Heart Failure Van N Selby, MD Assistant Professor of Medicine Advanced Heart Failure Program, UCSF October 9, 2015 Disclosures None 1 Cardiorenal Syndrome (CRS) A pathophysiologic
More informationAcute Kidney Injury. Eleanor Haskey BSc(hons) RVN VTS(ECC) VPAC A1
Acute Kidney Injury Eleanor Haskey BSc(hons) RVN VTS(ECC) VPAC A1 Anatomy and Physiology The role of the kidneys is to filter the blood through the glomerulus to form filtrate. The filtrate is then reabsorbed
More informationFluid Management in Critically Ill AKI Patients
Fluid Management in Critically Ill AKI Patients Sang Kyung Jo, MD, PhD Department of Internal Medicine Korea University Medical College KO/MG31/15-0017 Outline Fluid balance in critically ill patients:
More informationMinimizing the Renal Toxicity of Iodinated Contrast
Minimizing the Renal Toxicity of Iodinated Contrast Peter A. McCullough, MD, MPH, FACC, FACP, FAHA, FCCP Chief Academic and Scientific Officer St. John Providence Health System Detroit, MI USA Outline
More informationRCP : Regional Update in Medicine Acute Kidney Injury : A Renal Problem?
RCP : Regional Update in Medicine Acute Kidney Injury : A Renal Problem? Lui G Forni : Consultant Intensivist & Nephrologist Faculty of Health Sciences : University of Surrey Disclosures Research Funding
More informationA Clinical Approach to Acute Renal Failure. Jeffrey J. Kaufhold, MD FACP July 2017
A Clinical Approach to Acute Renal Failure Jeffrey J. Kaufhold, MD FACP July 2017 Summary Impact of ARF on hospitalized patients Causes of Acute Renal Failure Differential Pre-Renal Intra-renal Post-Renal
More informationThe Pharmacology of Hypotension: Vasopressor Choices for HIE patients. Keliana O Mara, PharmD August 4, 2018
The Pharmacology of Hypotension: Vasopressor Choices for HIE patients Keliana O Mara, PharmD August 4, 2018 Objectives Review the pathophysiology of hypotension in neonates Discuss the role of vasopressors
More informationRENAL FAILURE IN CHILDREN Dr. Mai Mohamed Elhassan Assistant Professor Jazan University
RENAL FAILURE IN CHILDREN Dr. Mai Mohamed Elhassan Assistant Professor Jazan University OBJECTIVES By the end of this lecture each student should be able to: Define acute & chronic kidney disease(ckd)
More informationHow and why I give IV fluid Disclosures SCA Fluids and public health 4/1/15. Andrew Shaw MB FRCA FCCM FFICM
How and why I give IV fluid Andrew Shaw MB FRCA FCCM FFICM Professor and Chief Cardiothoracic Anesthesiology Vanderbilt University Medical Center 2015 Disclosures Consultant for Grifols manufacturer of
More informationPerioperative renal protection
Key points Perioperative acute renal failure is a common complication of major surgery and is associated with increased morbidity and mortality. Ischaemia- or toxinmediated acute tubular necrosis is the
More informationRRT in Advanced Heart Failure and Liver Failure When to start and when to stop?
Critical Care Medicine Apollo Hospitals RRT in Advanced Heart Failure and Liver Failure When to start and when to stop? Ramesh Venkataraman, AB (Int. Med), AB (CCM) Senior Consultant, Critical Care Medicine
More informationENDPOINTS FOR AKI STUDIES
ENDPOINTS FOR AKI STUDIES Raymond Vanholder, University Hospital, Ghent, Belgium SUMMARY! AKI as an endpoint! Endpoints for studies in AKI 2 AKI AS AN ENDPOINT BEFORE RIFLE THE LIST OF DEFINITIONS WAS
More informationLESSONS FROM EVIDENCE BASED MEDICINEIN THE CARE OF ARF AND ESRD. Prof. Dr. Adrian Covic University of Medicine Gr. T. Popa, Iaşi
LESSONS FROM EVIDENCE BASED MEDICINEIN THE CARE OF ARF AND ESRD 2008 Prof. Dr. Adrian Covic University of Medicine Gr. T. Popa, Iaşi Effect of acute renal failure requiring renal replacement therapy on
More informationRenal Disease and PK/PD. Anjay Rastogi MD PhD Division of Nephrology
Renal Disease and PK/PD Anjay Rastogi MD PhD Division of Nephrology Drugs and Kidneys Kidney is one of the major organ of drug elimination from the human body Renal disease and dialysis alters the pharmacokinetics
More informationCardiorenal syndrome. Sofie Gevaert. Ghent University Hospital, Belgium
Cardiorenal syndrome Sofie Gevaert Ghent University Hospital, Belgium Disclosures Consultancy Astra Zeneca Boegringer MSD Novartis 68 y old man, ADHF ICMP, ejection fraction 35 %: progressive dyspnea,
More informationVasopressors in septic shock
Vasopressors in septic shock Prof. Jean-Louis TEBOUL Medical ICU Bicetre hospital University Paris-South France Questions 1- Why do we use vasopressors in septic shock? 2- Which first-line agent? 3- When
More informationNovel Sepsis Therapies
RSEM-GSA 17 Novel Sepsis Therapies Khaled Ahmed Alghamdi, MD, ABEM, FACEP, FAAEM Consultant Emergency Medicine Deputy program director Medical Director of Emergency Medical Services King Faisal Specialist
More informationActualités de la prise en charge hémodynamique initiale Daniel De Backer
Actualités de la prise en charge hémodynamique initiale Daniel De Backer Head Dept Intensive Care, CHIREC hospitals, Belgium Professor of Intensive Care, Université Libre de Bruxelles Past- President European
More informationDilemmas in Septic Shock
Dilemmas in Septic Shock William Janssen, M.D. Assistant Professor of Medicine National Jewish Health University of Colorado Denver Health Sciences Center A 62 year-old female presents to the ED with fever,
More informationCase year old female nursing home resident with a hx CAD, PUD, recent hip fracture Transferred to ED with decreased mental status BP in ED 80/50
Case 1 65 year old female nursing home resident with a hx CAD, PUD, recent hip fracture Transferred to ED with decreased mental status BP in ED 80/50 Case 1 65 year old female nursing home resident with
More informationAKI in Hospitalized Patients ACOI 2017
AKI in Hospitalized Patients ACOI 2017 Objectives 1. Define AKI KDIGO Classification 2. Incidence and consequences of AKI 3. Causes of AKI and workup 4. Prevention of AKI 5. Treatment of AKI AKI Case 67
More informationAvailable online at Vol. 10, Issue, 09, pp , September, DOI:
z ISSN: 0975-833X Available online at http://www.journalcra.com International Journal of Current Research Vol. 10, Issue, 09, pp.73768-73781, September, 2018 DOI: https://doi.org/10.24941/ijcr.32236.09.2018
More informationUse of Acute Kidney Injury Biomarkers in Clinical Trials
Use of Acute Kidney Injury Biomarkers in Clinical Trials Design Considerations Amit X. Garg MD, MA (Education), FRCPC, PhD Nephrologist, London Health Sciences Centre Professor, Medicine and Epidemiology
More informationUse of Acute Kidney Injury Biomarkers in Clinical Trials
Use of Acute Kidney Injury Biomarkers in Clinical Trials Design Considerations Amit X. Garg MD, MA (Education), FRCPC, PhD Nephrologist, London Health Sciences Centre Professor, Medicine and Epidemiology
More informationCase Scenario 3: Shock and Sepsis
Name: Molly Boyle 1. Define the term shock (Lewis textbook): Shock is a syndrome characterized by decreased perfusion and impaired metabolism. Shock can have a number of causes that result in damage to
More informationEFFECT OF EARLY VASOPRESSIN VS NOREPINEPHRINE ON KIDNEY FAILURE IN PATIENTS WITH SEPTIC SHOCK. Alexandria Rydz
EFFECT OF EARLY VASOPRESSIN VS NOREPINEPHRINE ON KIDNEY FAILURE IN PATIENTS WITH SEPTIC SHOCK Alexandria Rydz BACKGROUND- SEPSIS Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated
More informationWhen Fluids are Not Enough: Inopressor Therapy
When Fluids are Not Enough: Inopressor Therapy Problems in Neonatology Neonatal problem: hypoperfusion Severe sepsis Hallmark of septic shock Secondary to neonatal encephalopathy Vasoplegia Syndrome??
More informationRisk Factors and Management of Acute Renal Injury in Cardiac Surgery
Risk Factors and Management of Acute Renal Injury in Cardiac Surgery Robert S Kramer, MD, FACS Clinical Associate Professor of Surgery Tufts University School of Medicine Maine Medical Center, Portland
More informationDisorders of the kidney. Urine analysis. Nephrotic and nephritic syndrome.
Disorders of the kidney. Urine analysis. Nephrotic and nephritic syndrome. Azotemia and Urinary Abnormalities Disturbances in urine volume oliguria, anuria, polyuria Abnormalities of urine sediment red
More informationAcute Kidney Injury Is there a Best Practice?
Acute Kidney Injury Is there a Best Practice? M I T C H E L L R O S N E R, M D C h a i r m a n, D e p a r t m e n t o f M e d i c i n e U n i v e r s i t y o f V i r g i n i a H e a l t h S y s t e m Disclosures
More informationAcute Kidney Injury in The Acute Oncology Patient
Acute Kidney Injury in The Acute Oncology Patient Dr Andrew Lewington BSc MEd MD FRCP Consultant Renal Physician/Honorary Senior Lecturer Leeds Teaching Hospitals Definition Definitions and terminology
More informationIntraoperative Fluid Management. David G Hovord BA MB BChir FRCA Clinical Assistant Professor University of Michigan
Intraoperative Fluid Management David G Hovord BA MB BChir FRCA Clinical Assistant Professor University of Michigan Objectives Examine impact of perioperative renal failure, and discuss structure and function
More informationEARLY GOAL DIRECTED THERAPY : seminaires iris. Etat des lieux en Daniel De Backer
EARLY GOAL DIRECTED THERAPY : Etat des lieux en 2017 Daniel De Backer Head Dept Intensive Care, CHIREC hospitals, Belgium Professor of Intensive Care, Université Libre de Bruxelles Past-President European
More informationBiomarkers of renal diseases. By Dr. Gouse Mohiddin Shaik
By Dr. Gouse Mohiddin Shaik Introduction Renal system performs several functions Excretory Waste products like urea, creatinine, drug, toxins clearance Regulatory Water, electrolyte and acid base balance
More informationCardiorenal Syndrome: What the Clinician Needs to Know. William T. Abraham, MD Director, Division of Cardiovascular Medicine
Cardiorenal Syndrome: What the Clinician Needs to Know William T. Abraham, MD Director, Division of Cardiovascular Medicine Orlando, Florida October 7-9, 2011 Renal Hemodynamics in Heart Failure Glomerular
More informationHeart Failure and Renal Disease Cardiorenal Syndrome
Advanced Heart Failure: Clinical Challenges Heart Failure and Renal Disease Cardiorenal Syndrome 17 th Apr 2015 Ju-Hee Lee, M.D Cardiovascular Center, Chungbuk National University Hospital Chungbuk National
More informationPivotal Role of Renal Function in Acute Heart failure
Pivotal Role of Renal Function in Acute Heart failure Doron Aronson MD, FESC Department of Cardiology RAMBAM Health Care Campus Haifa, Israel Classification and definitions of cardiorenal syndromes CRS
More informationChronic Renal Failure Followed by Acute Renal Failure
Chronic Renal Failure Followed by Acute Renal Failure Dr Emre Karakoç Çukurova Üniversity Department of Medical ICU Terminology Acute Kidney Injury Chronic Kidney Disease Acute Kidney Disease Acute kidney
More informationMedical Treatment for acute Decompensated Heart Failure. Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011
Medical Treatment for acute Decompensated Heart Failure Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011 2010 HFSA guidelines for ADHF 2009 focused update of the 2005 American College
More informationSHOCK. Emergency pediatric PICU division Pediatric Department Medical Faculty, University of Sumatera Utara H. Adam Malik Hospital
SHOCK Emergency pediatric PICU division Pediatric Department Medical Faculty, University of Sumatera Utara H. Adam Malik Hospital 1 Definition Shock is an acute, complex state of circulatory dysfunction
More informationTitrating Critical Care Medications
Titrating Critical Care Medications Chad Johnson, MSN (NED), RN, CNCC(C), CNS-cc Clinical Nurse Specialist: Critical Care and Neurosurgical Services E-mail: johnsoc@tbh.net Copyright 2017 1 Learning Objectives
More informationCase - Acute Renal Failure
Case - Acute Renal Failure 73 yo diabetic F w hx of mild HBP but normal renal function develops infection of R foot. Over 1 week fever, chills, inflammation swelling of her R foot and leg. She takes Motrin
More informationSepsis and Septic Shock
Sepsis and Septic Shock James Allen, M.D. Division of Pulmonary & Critical Care Medicine The Ohio State University Does She Have Shock? A.Yes B.No C.Maybe Clinical Case Labs 55 yr old woman with nausea,
More informationINTENSIVE CARE MEDICINE CPD EVENING. Dr Alastair Morgan Wednesday 13 th September 2017
INTENSIVE CARE MEDICINE CPD EVENING Dr Alastair Morgan Wednesday 13 th September 2017 WHAT IS NEW IN ICU? (RELEVANT TO ANAESTHETISTS) Not much! SURVIVING SEPSIS How many deaths in England were thought
More informationSurviving Sepsis Campaign. Guidelines for Management of Severe Sepsis/Septic Shock. An Overview
Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis/Septic Shock An Overview Mechanical Ventilation of Sepsis-Induced ALI/ARDS ARDSnet Mechanical Ventilation Protocol Results: Mortality
More informationSURGICAL PATIENTS AT RISK FOR RENAL FAILURE. Dr.K.T.Ramadas Professor & Head, Department of Anaesthesiology Govt.Medical College, Thrissur
SURGICAL PATIENTS AT RISK FOR RENAL FAILURE Dr.K.T.Ramadas Professor & Head, Department of Anaesthesiology Govt.Medical College, Thrissur Introduction: Acute Kidney Injury (AKI), formerly known as Acute
More informationChapter 21. Diuretic Agents. Mosby items and derived items 2008, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 21 Diuretic Agents Renal Structure and Function Kidneys at level of umbilicus Each weighs 160 to 175 g and is 10 to 12 cm long Most blood flow per gram of weight in body 22% of cardiac output (CO)
More informationSepsis and Septic. James Allen, M.D. Division of Pulmonary & Critical Care Medicine The Ohio State University
Sepsis and Septic Shock James Allen, M.D. Division of Pulmonary & Critical Care Medicine The Ohio State University Clinical Case 55 yr old woman with nausea, vomiting, diarrhea for 3 days and progressive
More information1. Disorders of glomerular filtration
RENAL DISEASES 1. Disorders of glomerular filtration 2. Nephrotic syndrome 3. Disorders of tubular transport 4. Oliguria and polyuria 5. Nephrolithiasis 6. Disturbances of renal blood flow 7. Acute renal
More informationManagement of Acute Kidney Injury in the Neonate. Carolyn Abitbol, M.D. University of Miami Miller School of Medicine / Holtz Children s Hospital
Management of Acute Kidney Injury in the Neonate Carolyn Abitbol, M.D. University of Miami Miller School of Medicine / Holtz Children s Hospital Objectives Summarize the dilemmas in diagnosing & recognizing
More information