【持续性肾脏替代治疗CRRT英文精品课件】Acute Kidney Injury-AKI.pptVIP

Acute Kidney Injury AKI - an abrupt increase in serum creatinine of at least 0.3 mg /dl or 1.5 over baseline over 48 hours (based on AKI Network Consensus 2007) stage 1 increase in creatinine 1.5-2 fold stage 2 increase in creatinine 2-3 fold stage 3 increase in creatinine 3 fold (or need for dialysis or a peak Cr 4 mg/dl with at least a 0.5 mg/dl increase) Increased morbidity and mortality with increasing stage AKI - incidence and risks Hospitalized patients – 5 to 7.5% ICU – 10 to 30% AKI – associated with increased cost or length of hospital stay, risk of end-stage renal disease AKI -increased risk of death with AKI and sepsis, trauma, cardiopulmonary bypass, burn injuries (despite correction for comorbidities and severity of illness) Crit Care Med 2010:261 Hyperglycemia in hospital increases risk AKI Creatinine interpretation Increased BUN/creatinine ratio – pre-renal, blood in gut, obstruction, steroids, tetracycline Decreased BUN/creatinine ratio – rhabdomyolysis, reduced protein intake False elevations in creatinine – ketones, trimethoprim, cimetidine Rate of rise of creatinine – when daily creatinine elevation starts to go down a clue that renal function starting to improve eGFR – can not be calculated if Cr not stable Amputation - lower baseline creatinine Indicator AKI – relatively late; need renal “troponin” Replacement fluids Ringers lactate - since contains K+ do not give to oliguric patient ? NS – avoid in hyponatremic patient 0.9 NS resuscitation fluid of choice, but can worsen hyponatremia if SIADH Hydroxyethyl starch – increased incidence of AKI (osmotic nephrosis) ? NS + 1 amp NaHCO3 if very acidotic Colloid vs crystalloid 7000 patients in medical and surgical ICUs in Saline vs Albumin Fluid Evaluation (SAFE) - randomized, double-blind trial comparing NS vs 4% human albumin. Results - no difference in 28 day survival, days spent in the ICU, days on mechanical ventilator. Hypoalbuminemic patients - small randomized trial in which IV albumin