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1998, Number 4

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Med Crit 1998; 12 (4)

Acute renal failure in the critically ill patient

Cruz ME, Hernández-Rojas ME, Molinar RF, Hernández LD

Language: Spanish
References: 44
Page: 145-155
PDF size: 91.54 Kb.


ABSTRACT

Acute renal failure (ARF) ocurring in critically ill patients in the intensive care unit (ICU) is a common problem. Despite increasingly sophisticated renal replacement therapies (RRT), the mortality rate in ARF associated with multiorganic failure dysfunction, remains very high in our days. Acute tubular necrosis (ATN) in ICU patients is the most important injury associated with ARF. The manifestations of ARF include variyng degrees of oliguria, rising serum creatinine levels, reduction of the glomerular filtration rate (GFR), decrease of renal blood flow (RBF) and renal oxygen consumption, and tubular disorders. Since ARF is usually not immediately reversible, prevention is the most effective tool. The use of certain drugs (diuretics and b adrenergic agents, for example) to prevent, ameliorate or speed recovery, continues to be a controversial subject. Once ARF becomes established, therapy should be directed toward the prevention of complications. Because recovery from ARF may be delayed, the use of RRT is often necessary. ATN recovery is around 33%, ad integrum, and mortality rate is over 50%. In this article the most important features of the ARF of ICU patient are reviewed with special emphasis on its diagnosis.


REFERENCES

  1. Cruz ME. Función renal en el paciente crítico. Rev Asoc Med Crit y Ter Int 1996;10:50.

  2. Cruz ME, Hernández-Rojas ME, Hernández LD, Espinoza LF, Huerta TJ. Historia natural de la insuficiencia renal aguda y las dificultades para el diagnóstico. Rev Asoc Mex Med Crit y Ter Int 1990;4:77-84.

  3. Van Bommel EFH, Bouvy ND, So KL, Vicent HH, Zietse R, Bruining HA, Weimar W. High-risk surgical acute renal failure treated by continuous arteriovenous hemodiafiltration: metabolic control and outocome in sixty patients. Nephron 1995:185-192.

  4. Brown R, Babcock R, Talbert J, Gruennberg J, Czurak Ch, Campbell M. Renal function in critically ill postoperative patients: sequential assessment of creatinine osmolar and free water clearance. Crit Care Med 1980;8:68-72.

  5. Brezis M, Seymour R, Epstein F. Acute renal failure. En: Brenner BM, Rector FC, editores. The Kidney 4ª. Ed. Filadelfia: WB Saunders; 1991. p. 993-1061.

  6. Cotee DBF, Saul P. Is renal dose dopamine protective or therapeutic? Crit Care Clin 1996; 12: 687-694.

  7. Beaudry CI. Insuffisance rénale aiguë. En: Pequignot H, editor. Pathologie Médicale. 2ª. Ed. París: Masson 1979: p. 1030-1033.

  8. Iness A, Catto GRD. Renal failure. En: Nimmo WS, Rowbotham DJ, Smith G. Anaesthesia. 2ª. Ed. Oxford: Blackwell Science 1996: 27-47.

  9. Díaz de León PM, Aristondo GM. Insuficiencia renal aguda. Nefrología Mexicana 1990;11:63-69.

  10. Sillix GT, McDonald F. Acute renal failure. Crit Care Clin 1987:909-925.

  11. Coggins CH, Fang LST. Acute renal failure associated with antibiotics, anesthetic agents, and radiographic contrast agents. En: Brenner BM, Lazarus JM, editores. Acute Renal Failure 1ª. Ed. Filadelfia: WB Saunders 1983: 283-320.

  12. Shires GT, Shires III GT, Lowry SF. Fluid, electrolyte, and nutritional management of the surgical patient. En: Schwartz SI, Shires GT, Spencer FC, Husser WC, editores. Principles of Surgery. 5ª. Ed. New York: McGraw-Hill; 1994: p.61-93.

  13. Lucas ChE, Rector FE, Werner M, Rosenberg IK. Altered renal homeostasis with acute sepsis. Arch Surg 1973;106:444-449.

  14. Firmat J, Zucchini A, Martin R, Aguirre C. A study of 500 case of acute renal failure (1978-1991). Renal Failure 1994;16:91-99.

  15. Valtin H. Renal dysfunction: Mechanism involved in fluid and solute imbalance. 1ª. Ed. Filadelfia: Little Brown; 1979.

  16. Wagner OE, Lieske J, Toback G. Molecular and cell biology of acute renal failure: New therapeutic strategies. New Hor 1995;3:634-649.

  17. Chugh KS, Jha V, Sakhuja V. Acute renal cortical necrosis. A study of 113 patients. Renal Failure 1994;16:23-47.

  18. Cruz ME, Hernández-Rojas ME, Ramírez BM, Molinar RF. Necrosis renal cortical aguda. Rev Asoc Mex Med Crit y Ter Int 1996;10:73-75.

  19. Netter HF. Riñón, uréteres y vejiga urinaria. Colección Ciba de Ilustraciones Médicas. 1ª. Ed. Barcelona: Salvat 1978.

  20. Brown R. Renal dysfunction in the surgical patient. Maintenance of high output with furosemide. Crit Care Med 1979;7:63-68.

  21. Shin B, Mackenzie CF, Helrich M. Creatinine clearance for early detection of posttraumatic renal dysfunction. Anesthesiology 1986;64-605-609.

  22. Cruz ME, Hernández-Rojas ME, Baltazar TJA, Cárdenas ZG, Molinar RF. Riñón hiperdinámico: Características de las funciones glomerulotubulares en el paciente crítico con sepsis abdominal. Rev Asoc Mex Med Crit y Ter Int 1996;10:55-60.

  23. Dickson DM, Hillman KM. Continuos renal replacement in the critically ill. Anaesth Intens Care 1990;18:76-101.

  24. Mazze RI. Critical care of the patient with acute renal failure. Anesthesiology 1977;47:138-148.

  25. Gehr TWB, Schoolwerth AC. Adult acute and chronic renal failure. En: Shoemaker WC, Ayres SM, Grenvik A, Holbrook PR, editores. Textbook of Critical Care. 3ª. Ed. Filadelfia: WB Saunders 1995: p. 1029-1041.

  26. Faber MD, Kupin WL, Krishna GG, Narins RG. The differencial diagnosis of acute renal failure. En: Brenner BM, Lazarus JM, editores. Acute Renal Failure 1ª. Ed. Filadelfia: WB Saunders; 1983: p.133-192.

  27. Brady HR, Brenner BM. Acute renal failure. En: Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL et al, editores. Harrinson’s Principles of Internal Medicine. 14ª. Ed. New York: McGraw Hill; 1998: p. 1504-1513.

  28. Coyne DW. Renal Diseases. En: Cartey ChF, Lee HH, Woeltje KF, editores. The Washington Manual of Medical Therapeutics. 29ª. Ed. Filadelfia; 1998: p.227-242.

  29. Davin T. Renal dysfunction. En: Cerra FB, editor. Manual of Critical Care. 1ª. Ed. San Luis: Mosby 1987: p.458-479.

  30. Tadhani R, Pascual M, Bonventre JV. Acute renal failure. N Engl J Méd 1998; 334: 1448-1468

  31. Kirby RR, Taylor RW, Civetta JM, editores. Handbook of Critical Care. 1ª. Ed. Filadelfia: JB Lippincott; 1994.

  32. Bellomo R, Parkin G, Love J, Boyce N. Management of acute renal failure in the critically ill patient with continuous venovenous hemodiafiltration. Renal Failure 1992;14:183-186.

  33. Cruz ME, Hernández-Rojas ME, Baltazar TJA, Molinar RF, Hernández LD. Alteraciones gasométricas, hemodinámicas y metabólicas renales en pacientes críticos con insuficiencia renal aguda oligúrica. Rev Asoc Mex Med Crit y Ter Int 1995;9:159-166.

  34. Cruz ME, Hernández-Rojas ME, Molinar RF. Evaluación no invasiva del transporte de oxígeno renal en el paciente crítico. Rev Asoc Mex Med Crit y Ter Int 1996;10:269-275.

  35. Conlon PJ, Kovalik E, Schwab SJ. Percutaneous renal biopsy of ventilated intensive care unit patients. Clin Nephrol 1995;43:309-311.

  36. Cruz ME, Hernández-Rojas ME, Zambrana AM, García FR, Molinar RF. Shock: Conceptos actuales sobre clasificación, fisiopatología, diagnóstico y tratamiento. Rev Asoc Mex Med Crit y Ter Int 1995;9:49-58.

  37. Duke GJ, Briedis JH, Weaver RA. Renal support in critically ill patients: Low-dose dopamine or low dose-dobutamine. Crit Care Med 1994;22:1919-1925.

  38. Shilliday I, Allison MEM. Diuretics in acute renal failure. Renal Failure 1994;16:3-17.

  39. Lara GBM, Rosas GA, Cervantes OP. Estudio comparativo con dosis bajas de dobutamina y dopamina en el manejo de la insuficiencia renal en el paciente crítico. Rev Asoc Mex Med Crit y Ter Int 1998;12:79-83.

  40. García NJJ, Molinar RF, Baltazar TJA, Cervantes MC, Cruz ME. Comparación de los efectos renales de la dobutamina y la dopamina en pacientes en estado crítico. Rev Asoc Mex Med Crit y Ter Int 1996;10:154-158.

  41. 41 Brater DG. Diuretic Therapy. N Engl J Med 1998; 339: 387-395

  42. Cruz ME, Hernández-Rojas ME, Zambrana AM, Hernández LD, Molinar RF. Usos clínicos de la isoxsuprina en medicina crítica. Rev Asoc Mex Med Crit y Ter Int 1995;9:221-226.

  43. Bellomo R, Metha R. Acute renal replacement in the intensive care unit: Now and tomorrow. New Hor 1995;4:770-767.

  44. Forni LG, Hilton PJ. Continuous hemofiltration in the treatment of acute renal failure. New Engl J Med 1997;336:1303-1309.




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