Renal support therapy

2015 ◽  
Author(s):  
Claudio Ronco ◽  
Zaccaria Ricci
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Multiple Organ Failure ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Multiple Organ ◽  
Acute Illness ◽  
Renal Support Therapy ◽  
Critical Patients ◽  
Renal Support

Renal dysfunction is known to be frequently a component of multiple organ failure, a complex syndrome affecting the most severely ill critical patients. Bidirectional interaction between the kidneys and other organs has always been suspected; evidence suggests that severe kidney injury is an important protagonist in acute illness, even when managed by dialysis. In fact, if it seems that increasing the dose of renal replacement therapy does not reduce mortality, it could be inferred that acute kidney injury influences mortality through means that are not reversed by conventional renal support, either because the putative culprit toxins are not removed by renal replacement therapy or because renal replacement therapy is started too late to prevent these effects. It is known that the kidneys exert effects on other organs, such as the lung, liver, heart, and brain, in a process called ‘crosstalk’. This effect means that the kidney is not only a victim, but also a culprit regarding the malfunction of other organs. This chapter will detail some traditional aspects of different renal replacement therapy modalities and prescription schedules, but it will also describe the most recent evidence on the management and support of the kidney during failure of other organs.

Renal support therapy

2021 ◽  
pp. 338-350
Author(s):  
Claudio Ronco ◽  
Stefano Romagnoli ◽  
Zaccaria Ricci
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Multiple Organ Failure ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Multiple Organ ◽  
Acute Illness ◽  
Renal Support Therapy ◽  
Critical Patients ◽  
Renal Support

Renal dysfunction is known to be frequently a component of multiple organ failure, a complex syndrome affecting the most severely ill critical patients. Bidirectional interaction between the kidneys and other organs has always been suspected; evidence suggests that severe kidney injury is an important protagonist in acute illness, even when managed by dialysis. In fact, if it seems that increasing the dose of renal replacement therapy does not reduce mortality, it could be inferred that acute kidney injury influences mortality through means that are not reversed by conventional renal support, either because the putative culprit toxins are not removed by renal replacement therapy or because renal replacement therapy is started too late to prevent these effects. It is known that the kidneys exert effects on other organs, such as the lung, liver, heart, and brain, in a process called 'crosstalk'. This effect means that the kidney is not only a victim, but also a culprit regarding the malfunction of other organs. This chapter will detail some traditional aspects of different renal replacement therapy modalities and prescription schedules, but it will also describe the most recent evidence on the management and support of the kidney during failure of other organs.

Renal support therapy

2016 ◽  
Author(s):  
Claudio Ronco ◽  
Zaccaria Ricci
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Multiple Organ Failure ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Multiple Organ ◽  
Acute Illness ◽  
Renal Support Therapy ◽  
Critical Patients ◽  
Renal Support

Renal dysfunction is known to be frequently a component of multiple organ failure, a complex syndrome affecting the most severely ill critical patients. Bidirectional interaction between the kidneys and other organs has always been suspected; evidence suggests that severe kidney injury is an important protagonist in acute illness, even when managed by dialysis. In fact, if it seems that increasing the dose of renal replacement therapy does not reduce mortality, it could be inferred that acute kidney injury influences mortality through means that are not reversed by conventional renal support, either because the putative culprit toxins are not removed by renal replacement therapy or because renal replacement therapy is started too late to prevent these effects. It is known that the kidneys exert effects on other organs, such as the lung, liver, heart, and brain, in a process called ‘crosstalk’. This effect means that the kidney is not only a victim, but also a culprit regarding the malfunction of other organs. This chapter will detail some traditional aspects of different renal replacement therapy modalities and prescription schedules, but it will also describe the most recent evidence on the management and support of the kidney during failure of other organs.

Renal support therapy

2018 ◽  
Author(s):  
Claudio Ronco ◽  
Zaccaria Ricci
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Multiple Organ Failure ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Multiple Organ ◽  
Acute Illness ◽  
Renal Support Therapy ◽  
Critical Patients ◽  
Renal Support

Renal dysfunction is known to be frequently a component of multiple organ failure, a complex syndrome affecting the most severely ill critical patients. Bidirectional interaction between the kidneys and other organs has always been suspected; evidence suggests that severe kidney injury is an important protagonist in acute illness, even when managed by dialysis. In fact, if it seems that increasing the dose of renal replacement therapy does not reduce mortality, it could be inferred that acute kidney injury influences mortality through means that are not reversed by conventional renal support, either because the putative culprit toxins are not removed by renal replacement therapy or because renal replacement therapy is started too late to prevent these effects. It is known that the kidneys exert effects on other organs, such as the lung, liver, heart, and brain, in a process called ‘crosstalk’. This effect means that the kidney is not only a victim, but also a culprit regarding the malfunction of other organs. This chapter will detail some traditional aspects of different renal replacement therapy modalities and prescription schedules, but it will also describe the most recent evidence on the management and support of the kidney during failure of other organs.

scholarly journals Primary Injuries and Secondary Organ Failures in Trauma Patients with Acute Kidney Injury Treated with Continuous Renal Replacement Therapy

Scientifica ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Sigrid Beitland ◽  
Ingrid Os ◽  
Kjetil Sunde
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Multiple Organ Failure ◽  
Replacement Therapy ◽  
Organ Failure ◽  
Kidney Injury ◽  
Multiple Organ ◽  
Trauma Patients ◽  
Organ Failures

Background. Acute kidney injury (AKI) treated with continuous renal replacement therapy (CRRT) is a severe complication in trauma patients. The aim of the study was to assess primary traumatic injuries and secondary organ failures in severe posttraumatic AKI.Methods. Retrospective review of adult trauma patients admitted to the trauma centre at Oslo University Hospital Ullevål. Injury severity score (ISS) was used to assess the severity of primary injuries, and sequential organ failure assessment (SOFA) score was utilized to measure secondary organ failures.Results. Forty-two (8%) of 506 trauma patients admitted to intensive care unit developed AKI treated with CRRT, whereof 40 (95%) suffered blunt trauma mechanisms. Patients had extensive primary organ injuries with median (interquartile range) ISS 36 (27–49). The majority of the patients had respiratory (93% intubated) and cardiovascular (67% with inotropic and/or vasoactive medication) failure within 24 hours after admission. AKI was often part of multiple organ failure, most frequently respiratory and cardiovascular failure, affecting 33 (75%) and 30 (71%) of the patients, respectively.Conclusion. Trauma patients with AKI undergoing CRRT often had severe primary injuries due to blunt trauma. Most of them suffered from secondary multiple organ failure concomitant to AKI.

scholarly journals Delayed Admission and Management of Pediatric Acute Kidney Injury and Multiple Organ Dysfunction Syndrome in Children with Multiple Wasp Stings: A Case Series

2019 ◽  
Vol 9 (3) ◽  
pp. 137-148 ◽  
Author(s):  
Cahyani Gita Ambarsari ◽  
Risti Maulani Sindih ◽  
Meilania Saraswati ◽  
Partini Pudjiastuti Trihono
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Organ Dysfunction ◽  
Steroid Therapy ◽  
Kidney Injury ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
First Case ◽  
Wasp Stings

Multiple wasp stings may cause fatal complications, such as anaphylactic reactions, intravascular hemolysis, rhabdomyolysis, acute kidney injury (AKI), increased levels of liver enzymes, clotting abnormalities, or even death. AKI-related mortality due to multiple wasp stings may reach 25%, occurring within the early onset of disease; therefore, renal function should be continuously monitored within the first few days following the stings. Herein, we report 2 cases of AKI due to multiple stings of wasp (Vespa affinis). In both cases, delayed hospital admissions and gradual loss of kidney function along with hemolysis and anemia without rhabdomyolysis were observed. Diuresis was reduced on the 10th day following the stings in the first case, whereas it occurred on the 5th day in the second case. Both cases had biopsy results of acute tubular injury and acute interstitial nephritis. The first case improved with intermittent hemodialysis, whereas the second required continuous renal replacement therapy and plasma exchange because hemolysis was more severe, which was presumably caused by a greater number of stings and larger amount of toxins involved. Multiple organ dysfunction syndrome was also observed in the second case; hence, high-dose steroid therapy was administered to alleviate interstitial fibrosis. Both cases showed that although AKI occurring after multiple wasp stings usually have fatal consequences. Administering fluid treatment and steroid therapy and selecting accurate renal replacement therapy modalities during the few first days after the stings may result in favorable long-term outcomes.

scholarly journals Rhabdomyolysis-Induced Acute Renal Injury in a Schizophrenic Patient

2020 ◽  
Vol 6 (4) ◽  
pp. 249-252
Author(s):  
Mirela Tiglis ◽  
Tudor Hurmuzache ◽  
Cristina Bologa ◽  
Tiberiu Paul Neagu ◽  
Liliana Mirea ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Renal Injury ◽  
Supportive Therapy ◽  
Kidney Injury ◽  
Signs And Symptoms ◽  
Rapid Identification ◽  
Multiple Organ ◽  
Volume Resuscitation

AbstractNowadays, schizophrenia is treated with atypical antipsychotics that can determine neuroleptic malignant syndrome or rhabdomyolysis appearance. In addition to trauma and muscular hypoxia, there are some drugs and toxins associated with rhabdomyolysis development, among which olanzapine. A case of severe rhabdomyolysis syndrome, with extremely high levels of serum creatine kinase (CK), followed by acute kidney failure, secondary to olanzapine overdose and prolonged immobilization is outlined. Continuous renal replacement therapy was performed, with a slow clearance of serum CK levels. Under supportive therapy, systemic alkalinisation with volume resuscitation and corticotherapy, patient’s general condition was improved, as well as his lower limb paresis. He followed frequent psychiatric evaluations and psychotherapies, before and after being transferred to a medical service. Rhabdomyolysis diagnosis is difficult in mild cases due to non-specific signs and symptoms, but it also has some typical manifestation, generically called “the rhabdomyolysis syndrome triad”. The treatment is usually supportive; renal replacement therapy is required in the presence of acute kidney injury unresponsive to aggressive volume resuscitation. The systemic myoglobin release is responsible for renal injury. Olanzapine muscle toxicity can lead to severe rhabdomyolysis syndrome complicated with acute kidney injury and multiple organ dysfunction syndrome. Rapid identification and aggressive therapeutic management are essential for improving patients’ outcome and prevent the occurrence of irreversible injuries.

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