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Colegio de Medicina Interna de México.

2013, Number 2

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Med Int Mex 2013; 29 (2)

Current affairs in sharp renal malfunction and therapy of renal support

Carrillo-Esper R, Vázquez-Rangel A, Merino-López M, Peña-Pérez C, Nava-López J, Espinoza de los Monteros-Estrada I, de la Torre-León T, Rosales-Gutiérrez AO, Carrillo-Córdova LD, Carrillo-Córdova DM, Carrillo-Córdova CA

Language: Spanish
References: 48
Page: 179-191
PDF size: 417.30 Kb.


ABSTRACT

Acute Kidney injury (AKI) is a frequent complication in hospitalized patients. AKI is often overlooked in hospitalized patients despite the fact even mild forms are strongly associated with poor clinical outcomes such as increased mortality, morbidity, cardiovascular failure and infections. In recent years the pathogenic mechanisms of AKI have been fully elucidated. Tubular epithelial cells and endothelial cells, endothelial junction injury, membrane transporters and tigh junction proteins have been identified as the main targets of ischemia and other lesion mechanisms. RIFLE (Risk, Injury, Failure, Loss, End Stage Kidney Disease) and AKIN ( Acute Kidney Injury Network) criteria wich was designed to standardize and classify renal dysfunction. The RIFLE and AKIN criteria are easy to use in a variety of clinical and research settings, but have several limitations; both utilize an increase in serum creatinine level from a hypothetical baseline value and a decrease in urine output. The diagnosis of AKI is usually based on changes in serum creatinine, but such measurement is a poor marker of acute deterioration in kidney function. Recent studies evidenced new molecules as early biomarkers of AKI, in special the Neutrophil Gelatinase-Associated Lipocalin (NGAL), as useful tools for diagnosis, stratification and prognostication of AKI. The early initiation and new modalities of the of Renal Replacement Therapy (RRT) are associated with improved survival.


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