0
selected
-
1.
Cardiorenal Syndrome in Acute Kidney Injury.
Di Lullo, L, Reeves, PB, Bellasi, A, Ronco, C
Seminars in nephrology. 2019;(1):31-40
Abstract
Varying degrees of cardiac and kidney dysfunction commonly are observed in hospitalized patients. As a demonstration of the significant interplay between the heart and kidneys, dysfunction or injury of one organ often contributes to dysfunction or injury of the other. The term cardiorenal syndrome (CRS) was proposed to describe this complex organ cross-talk. Type 3 CRS, also known as acute renocardiac syndrome, is a subtype of CRS that occurs when acute kidney injury contributes to or precipitates the development of acute cardiac dysfunction. Acute kidney injury may directly or indirectly produce acute cardiac dysfunction by way of volume overload, metabolic acidosis, electrolyte disorders such as hyperkalemia and hypocalcemia, and other mechanisms. In this review, we examine the definition, epidemiology, pathophysiology, and treatment options for CRS with an emphasis on type 3 CRS.
-
2.
Nutritional management in the critically ill child with acute kidney injury: a review.
Sethi, SK, Maxvold, N, Bunchman, T, Jha, P, Kher, V, Raina, R
Pediatric nephrology (Berlin, Germany). 2017;(4):589-601
Abstract
Acute kidney injury (AKI) in critically ill children is frequently a component of the multiple organ failure syndrome. It occurs within the framework of the severe catabolic phase determined by critical illness and is intensified by metabolic derangements. Nutritional support is a must for these children to improve outcomes. Meeting the special nutritional needs of these children often requires nutritional supplementation by either the enteral or the parenteral route. Since critically ill children with AKI comprise a heterogeneous group of subjects with varying nutrient needs, nutritional requirements should be frequently reassessed, individualized and carefully integrated with renal replacement therapy. This article is a state-of-the-art review of nutrition in critically ill children with AKI.
-
3.
[Acute Kidney Injury, Type - 3 cardiorenal syndrome, Biomarkers, Renal Replacement Therapy].
Di Lullo, L, Bellasi, A, Barbera, V, Cozzolino, M, Russo, D, De Pascalis, A, Santoboni, F, Villani, A, De Rosa, S, Colafelice, M, et al
Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia. 2016;(3)
Abstract
Cardiovascular disease and major cardiovascular events represent main cause of death in both acute and chronic kidney disease patients. Kidney and heart failure are common and frequently co-exist This organ-organ interaction, also called organ cross-talk, leads to well-known definition of cardiorenal syndrome (CRS). Here we will describe cardiovascular involvement in patients with acute kidney injury (AKI). Also known as Type-3 CRS or acute reno-cardiac CRS, it occurs when AKI contributes and/or precipitates development of acute cardiac injury. AKI may directly or indirectly produces an acute cardiac event and it can be associated with volume overload, metabolic acidosis and electrolytes disorders such as hyperkalemia and hypocalcemia, coronary artery disease, left ventricular dysfunction and fibrosis which has been also described in patients with AKI with the consequence of direct negative effects on cardiac performance.
-
4.
Protein/energy debt in critically ill children in the pediatric intensive care unit: acute kidney injury as a major risk factor.
Sabatino, A, Regolisti, G, Maggiore, U, Fiaccadori, E
Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation. 2014;(4):209-18
Abstract
Acute kidney injury (AKI) is common in pediatric intensive care unit (PICU) patients. In this clinical setting, the risk of protein-energy wasting is high because of the metabolic derangements of the uremic syndrome, the difficulties in nutrient needs estimation, and the possible negative effects of renal replacement therapy itself on nutrient balance. No specific guidelines on nutritional support in PICU patients with AKI are currently available. The present review is aimed at evaluating the role of AKI as a risk condition for inadequate protein/energy intake in these patients, on the basis of literature data on quantitative aspects of nutritional support in PICU. Current evidence suggests that a relevant protein/energy debt, a widely accepted concept in the literature on adult intensive care unit patients with its negative implications for patients' major outcomes, is also likely to develop in pediatric critically ill patients, and that AKI represents a key factor for its development.
-
5.
Specialized nutritional support interventions in critically ill patients on renal replacement therapy.
Fiaccadori, E, Regolisti, G, Maggiore, U
Current opinion in clinical nutrition and metabolic care. 2013;(2):217-24
Abstract
PURPOSE OF REVIEW Optimal nutritional requirements and nutrient intake composition for patients with acute kidney injury remain a partially unresolved issue. Targeting nutritional support to the actual protein and energy needs improves the clinical outcome of critically ill patients, yet very few data are currently available on this topic in acute kidney injury. In this specific clinical condition the risk for underfeeding and overfeeding may be increased by factors interfering on nutrient need estimation, such as rapidly changing body weight due to fluid balance variations, nutrient losses and hidden calorie sources from renal replacement therapy. Moreover, as acute kidney injury is now considered a kidney-centered inflammatory syndrome, the renoprotective role of specific pharmaconutrients with anti-inflammatory properties remains to be fully defined. This review is aimed at discussing recently published results concerning quantitative and qualitative aspects of the nutritional approach to acute kidney injury in critically ill patients. RECENT FINDINGS Nutrient needs in patients with acute kidney injury can be difficult to estimate, and should be directly measured, especially in the ICU setting. In fact, recent findings suggest that hidden calorie sources not routinely taken into account - for example, calories from anticoagulants and replacement solutions for renal replacement therapy - could be quantitatively relevant in these patients. Moreover, recent experimental data indicate a possible role for some pharmaconutrients with anti-inflammatory effects (glutamine, and omega-3 fatty acids), in both the prevention of renal function worsening, and in the fostering of renal function recovery after an episode of acute kidney injury. SUMMARY Acute kidney injury includes a highly heterogeneous group of patients with widely varying nutrient needs and intakes. Nutritional requirements, in their quantitative and qualitative aspects, should be frequently assessed, individualized, and carefully integrated with renal replacement therapy, in order to avoid both underfeeding and overfeeding, as well as to exploit possible positive pharmacologic effects of specific nutrients.
-
6.
Nutritional support in acute renal failure.
Chan, LN
Current opinion in clinical nutrition and metabolic care. 2004;(2):207-12
Abstract
PURPOSE OF REVIEW Acute renal failure is commonly present in patients with sepsis, shock, trauma, burn injury, or multi-organ dysfunction syndrome. Acute renal failure is an independent risk factor contributing to increased hospital mortality. The major complications associated with acute renal failure include metabolic derangement and protein catabolism. The purpose of this article is to review the literature between 2001 and December 2003, to determine whether newer studies have provided a better understanding of the optimization of caloric and protein delivery to critically ill patients with acute renal failure receiving continuous renal replacement therapy. RECENT FINDINGS Continuous renal replacement therapy is now widely used in the intensive care unit to manage patients with acute renal failure, because it is better tolerated than intermittent hemodialysis by patients who are hemodynamically unstable. Although continuous renal replacement therapy is highly efficient in the removal of toxins and metabolic wastes, it may also lead to an excessive loss of nutrients, which include intact protein and amino acids. Data describing the optimal nutritional support regimen for patients receiving continuous renal replacement therapy are very limited. SUMMARY The results and findings from this review may help clinicians to individualize caloric and protein delivery for patients with acute renal failure. The ultimate goal is to tailor the regimen towards the needs of each individual patient in order to maximize the benefit of nutritional support, in the hope of improving patient survival.