Critical Care Nephrology

3rd Edition - November 29, 2017
Authors: Claudio Ronco, Rinaldo Bellomo, John Kellum, Zaccaria Ricci
Language: English
Hardback ISBN:
9 7 8 - 0 - 3 2 3 - 4 4 9 4 2 - 7
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 5 1 1 9 9 - 5

Comprehensive and clinically relevant, the 3rd Edition of Critical Care Nephrology provides authoritative coverage of the latest advances in critical care procedures for patients… Read more

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Comprehensive and clinically relevant, the 3rd Edition of Critical Care Nephrology provides authoritative coverage of the latest advances in critical care procedures for patients with renal diseases or disorders. Using common guidelines and standardized approaches to critically ill patients, this multidisciplinary reference facilitates better communication among all physicians who care for critically ill patients suffering from kidney disease, electrolyte and metabolic imbalances, poisoning, severe sepsis, major organ dysfunction, and other pathological events.

Cover image
Title Page
Table of Contents
Copyright
Dedication
Contributors
Preface
Section 1 Principles of Critical Care
1 The Critically Ill Patient
Abstract
Organ Dysfunction
Principles of Management: The VIP Rule
Monitoring Systems
The ICU Stay as Part of a Trajectory
Conclusion
Key Points
References
2 The Pathophysiologic Foundations of Critical Care
Principles
Applied Physiology at the Bedside
Basics of Cardiovascular Physiology
Circulatory Shock: Resuscitation Guidelines and Protocols
Sepsis and Septic Shock
Summary
Key Points
References
3 Mechanical Ventilation
Abstract
Physiology Relevant to Ventilatory Support
Indications for Mechanical Ventilation
Types of Invasive Ventilation
Modes and Settings
General Principles of Patient Management
Tools for the Bedside
Specifics of Patient Management
Discontinuation of Ventilatory Support
Noninvasive Ventilation
Conclusion
Key Points
References
4 Hemodynamic Support in the Critically Ill Patient
Abstract
Hemodynamic Monitoring
Pharmacologic Cardiovascular Support
Nonpharmacologic Cardiovascular Support
Conclusion
Key Points
References
5 Monitoring Organ Dysfunction in Critical Care
Principles of Biomarker Analysis to Assess Organ Dysfunction
Neurologic Functional Assessment
Conclusion
Key Points
References
6 Kidney-Specific Severity Scores
Abstract
Kidney-Specific Severity Scores and Their External Validation
Problems of Currently Available Kidney-Specific Severity Scores
Key Points
References
Section 2 Principles of Renal Physiology
7 The Physiology of the Glomerulus
Abstract
Basic Anatomy
Flow Regulation
Glomerular Capillaries
Mechanical Filtration
Podocytes
Mesangium
Key Points
References
8 The Physiology of the Loop of Henle
Abstract
Sodium Transport and the Countercurrent System
Acid-Base Transport
Ammonia and Ammonium Ion Transport
The Function of the Macula Densa
Transport of Divalent Cations
Conclusion
Key Points
References
9 Glomerular Filtration Rate, Renal Functional Reserve, and Kidney Stress Testing
Abstract
Mechanism of Glomerular Filtration
Measurement of Glomerular Filtration Rate
GFR and Estimated GFR in Acute Kidney Injury
Renal Functional Reserve and Renal Stress Testing
Key Points
References
10 Renal Energy Consumption and Metabolism
Abstract
Normal Renal Bioenergetics
Renal Bioenergetics in Acute Kidney Injury
Interventions Affecting Renal Bioenergetics
Conclusion
Key Points
References
Section 3 Epidemiology of Acute Kidney Injury in Critical Care
11 Acute Kidney Injury
Normal Kidney
Increased Susceptibility
Acute Kidney Stress
Renal Angina
Concept of Subclinical Acute Kidney Injury
Molecular Diagnosis of Acute Kidney Injury
Constitution of Nephrocheck Rapid Response Team
Conclusion
Key Points
References
12 Community- and Hospital-Acquired Acute Kidney Injury
Abstract
Community-Acquired Acute Kidney Injury
Hospital-Acquired Acute Kidney Injury
Cause of Acute Kidney Injury
Contrast-Induced Acute Kidney Injury
Community-Acquired Pneumonia and Acute Kidney Injury
Drugs and Acute Kidney Injury
Sepsis and Acute Kidney Injury
Human Immunodeficiency Virus Infection and Acute Kidney Injury
Malaria and Acute Kidney Injury
Gyneco-Obstetric and Acute Kidney Injury
Postoperative Acute Kidney Injury
Acute Kidney Injury in the Elderly Population
Conclusion
Key Points
References
13 Epidemiology of Acute Kidney Injury in Critically Ill Patients
Abstract
Incidence of Acute Kidney Injury
Etiology of Acute Kidney Injury and Risk Factors for Acute Kidney Injury
Outcomes of Acute Kidney Injury
Key Points
References
14 Acute Kidney Injury in Patients With Chronic Kidney Disease
Abstract
Chronic Kidney Disease and the Development of Acute Kidney Injury
Acute Kidney Injury and the Progression of Chronic Kidney Disease
Management End-Stage Renal Disease Patients in the Intensive Care Unit
Conclusion
Key Points
References
Section 4 Exposures and Patient Susceptibility
15 Genetic Predisposition for Acute Kidney Injury (AKI)
Abstract
Background
Difficulties in Defining the Genes of Interest in Acute Kidney Injury
Genes Associated With Acute Kidney Injury
Future Directions: Genome-Wide Associations
Key Points
References
16 Risk Factors and Risk Assessment in Acute Kidney Injury
Abstract
Risk Assessment and Preventative Strategies
Summary
Key Points
References
17 Experimental Models of Acute Kidney Injury
Abstract
In vitro Models of Acute Kidney Injury
In Vivo Models of Acute Kidney Injury
Translation to Human Disease
Emerging Research Techniques
Summary
Key Points
References
Section 5 Humoral and Cellular Mechanisms of Kidney Damage
18 Renal Blood Flow and Perfusion Pressure
Abstract
Relationship Between Renal Blood Flow and Perfusion Pressure, or Renal Autoregulation
Determinants of Perfusion Pressure
Conclusion
Key Points
References
19 Humoral Mediators in Sepsis
Abstract
Humoral Mediators in the Pathogenesis of Sepsis
Key Points
References
20 Cell Death Pathways
Abstract
Mechanisms of Cell Death
Regulated Cell Death
Cell Death in Acute Kidney Injury
Apoptosis During Acute Kidney Injury
Cell Death Regulated by Necrosis During Acute Kidney Injury
Potential Therapies
Key Points
References
21 Pathogen-Associated Molecular Patterns, Damage-Associated Molecular Patterns, and Their Receptors in Acute Kidney Injury
Abstract
PAMPs and DAMPs
Pattern Recognition Receptors
Toll-Like Receptors
Nod-Like Receptors, Signalosomes, and Inflammasomes
PAMPs, DAMPs, and PRRs in Acute Kidney Injury
Conclusion
Key Points
References
Section 6 Clinical Course of Acute Kidney Injury and Biomarkers
22 Acute Kidney Disease
Acute and Chronic Kidney Disease
Key Points
References
23 Acute Kidney Disease, Renal Recovery, and Post–Acute Kidney Injury Care
Abstract
Acute Kidney Injury and Associated Outcomes
Development of CKD After AKI (AKI Transition to CKD)
Recognition and Detection of Persistent Renal Injury and Renal Recovery
Care After Acute Kidney Injury
Summary and Future Directions
Key Points
References
24 The Role of Biomarkers in the Diagnosis and Management of Acute Kidney Injury
Abstract
Role of Biomarkers in Acute Kidney Injury Risk Stratification
Role of Biomarkers in Early Diagnosis of Acute Kidney Injury
Role of Biomarkers in Acute Kidney Injury Intervention
Role of Biomarkers in Acute Kidney Injury Prognosis
Biomarkers in Acute Kidney Injury: Pediatric Perspective
Key Points
References
25 Functional Biomarkers
Abstract
Background
Creatinine and the Assessment of Renal Function
Mathematical Estimation of Glomerular Filtration Rate
Clearance Measurements
Alternative Glomerular Filtration Markers
Urine Output as a Renal Functional Biomarker
Key Points
References
26 Damage Biomarkers
Abstract
Urinary Damage Biomarkers of Acute Kidney Injury: The Search for “Renal Troponin I”
Damage Biomarkers Studied in Hospitalized Patients
AKI After Cardiopulmonary Bypass in Children: The Ideal Clinical Setting for Damage Biomarker Assessment
Damage Acute Kidney Injury Biomarkers in Other Settings
Key Points
References
27 Kidney Stress Biomarkers
Abstract
Stress Response
Kidney Stress Biomarkers: Clinical Applications and Summary
Summary
Key Points
References
Section 7 Mechanisms of Repair or Progression
28 Renal Repair and Recovery
Abstract
Normal Renal Architecture
Acute Kidney Injury: Common Pathophysiologic Mechanisms of Injury
Recovery From Acute Kidney Injury: Mechanisms of Maladaptive Repair
Recovery From Acute Kidney Injury: the Progenitor Cell
Recovery From Acute Injury: the Cellular Stress Response
Recovery From Acute Injury: Role of Endothelium
Recovery From Acute Injury: Role of Growth Factors
Emerging Research Areas: Role of Epigenetics in Acute Kidney Injury
Strategies to Accelerate Renal Recovery: Human Studies
Conclusion
Key Points
Acknowledgments
References
29 Maladaptive Repair and Progression to CKD
Abstract
Resident Cells
Innate Immune System
Adaptive Immune System
Key Points
References
30 Biomarkers of Recovery and/or Repair Following Acute Kidney Injury
Abstract
Conventional Measures
The Future
Conclusions
Key Points
References
Section 8 Renal Histopathology in Acute Kidney Injury
31 Practical Considerations of Renal Biopsies in Critical Care Patients
Abstract
Indications and Contraindications for Renal Biopsy
Biopsy Technique and Modalities
Pre- and Postbiopsy Management
Diagnosis and Therapy
Conclusion
Key Points
References
32 Localization of Injury and Repair Pathways
Abstract
Localization of Injury
Adaptive Repair After Acute Kidney Injury: the Renal Stress Response
Other Adaptive and Reparative Mechanisms
Renal Repair After Acute Kidney Injury: Evidence for the Existence of a Tubular Progenitor Response
Conclusion
Key Points
References
Section 9 Imaging Techniques in Critical Care Nephrology
33 Ultrasonography and Doppler Techniques
Abstract
Definition of Acute Kidney Injury
Pathogenesis of Acute Damage and Role of Microcirculation
Role of Ultrasound in Clinical WorkUp
PreRenal Acute Kidney Injury
Parenchymal Acute Kidney Injury
Postrenal AKI
Key Points
References
34 Contrast-Enhanced Renal Ultrasound
Background
Contrast-Enhanced Ultrasonography
Clinical Applications for Renal Contrast-Enhanced Ultrasonography
Blood Flow Quantification With Contrast-Enhanced Ultrasonogaphy
Conclusion
Key Points
References
35 Traditional Radiology, Computed Tomography, and Magnetic Resonance Imaging in Critical Care Nephrology
Abstract
Computed Tomography
Magnetic Resonance Imaging
Functional Magnetic Resonance Imaging
Key Points
References
36 Radionuclides Diagnostic Techniques
Abstract
Principles of Nuclear Medicine
Radionuclides Techniques in Renal Evaluation
Role of Nuclear Medicine in Cardiac Diseases
Role of Nuclear Medicine in Inflammation, Infection, and Cancer Diseases
Key Points
References
Section 10 Clinical Syndromes and Acute Kidney Injury
37 Multiple Organ Dysfunction
Abstract
Mechanisms
An Adaptive State?
Reversal of Multiorgan Dysfunction Syndrome and Recovery
Future Therapies
Summary
Key Points
References
38 Acute Kidney Injury in Burns and Trauma
Abstract
Traumatic Acute Kidney Injury
Epidemiology of Acute Kidney Injury in Major Trauma
Cause of Acute Kidney Injury After Major Trauma
Rhabdomyolysis
Burn Injuries and Acute Kidney Injury
Pathophysiology of Acute Kidney Injury in Burns
Management of the Burns Patient With Acute Kidney Injury
Outcomes and Follow-Up After Acute Kidney Injury in Trauma or Burns
Key Points
References
39 Drug-Induced Acute Kidney Injury
Abstract
Antiinfective Agents
Nonsteroidal Antiinflammatory Drugs
Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Blockers, and Renin Inhibitors
Chemotherapeutic Agents
Key Points
References
40 Acute Kidney Injury in Pregnancy
Abstract
Epidemiology of Acute Kidney Injury in Pregnancy
Renal Physiology: Alterations in Pregnancy
Fetal Considerations
Causes of Pregnancy-Related Acute Kidney Injury
Evidence-Based Approach to Evaluation and Management of Pregnancy-Related Acute Kidney Injury
Conclusion
Key Points
References
41 Acute Kidney Injury in Oncology and Tumor Lysis Syndrome
Abstract
Epidemiology and Risk Factors
Acute Kidney Injury in Solid Tumors
Acute Kidney Injury in Hematologic Malignancies
Acute Kidney Injury in Hematopoietic Stem Cell Transplantation
Hepatic Sinusoidal Obstruction Syndrome
Tumor Lysis Syndrome
Thrombotic Microangiopathies
Acute Kidney Injury in Renal Cell Carcinoma and Urothelial Cancers
Acute Kidney Injury in Abdominal Compartment Syndrome
Contrast-Induced Nephropathy in Cancer Patients
Conclusion
Key Points
References
42 Acute Kidney Injury in Cardiac Surgery
Abstract
Definition of Cardiac Surgery–Associated Acute Kidney Injury
Pathophysiology of Cardiac Surgery–Associated Acute Kidney Injury
Cardiopulmonary Bypass
Assessing Renal Function and Acute Kidney Injury
Interventions to Prevent Acute Kidney Injury
Key Points
References
43 Acute Kidney Injury in Major Surgery
Abstract
Epidemiology and Outcomes in Surgical Patients
Prevention and Treatment
Summary
Key Points
References
44 Acute Kidney Injury in Heart Failure
Abstract
Pathophysiology
Prognosis
Conclusion
Key Points
References
45 Acute Kidney Injury in Cirrhosis
Abstract
Pathophysiology of Acute Kidney Injury in Cirrhosis
Assessment of Kidney Function
Definition of Acute Kidney Injury
Cause of Acute Kidney Injury
Prevention of Acute Kidney Injury
Evaluation and Management of Acute Kidney Injury
Acute Kidney Injury in Candidates for Liver Transplantation
Biomarkers
Key Points
References
46 Acute Renal Failure in Kidney Transplant Recipients
Abstract
Epidemiology of Acute Kidney Injury in the Early Postrenal Transplantation Period
Pathophysiology of Posttransplant Acute Kidney Injury
Long-Term Graft Dysfunction Outcomes
Clinical Evaluation
Management of Risk Factors for Acute Kidney Injury and Delayed Graft Function
Future Diagnostics in Acute Kidney Injury
Management of Acute Kidney Injury Posttransplant and With Delayed Graft Function
Conclusion
Key Points
References
47 Acute Glomerulonephritis
Abstract
Approach to Management of Rapidly Progressive Glomerulonephritis
Clinical Presentation and Management of Rapidly Progressive Glomerulonephritis
Other Types of Glomerulonephritis That Cause Acute Renal Failure
Key Points
Acknowledgments
References
48 Contrast-Induced Acute Kidney Injury
Abstract
Registry Data on Contrast-Induced Acute Kidney Injury
Renal Injury Resulting From Iodinated Contrast
Clinical Outcomes
Principles of Prevention and Management
Future Developments
Conclusion
Key Points
References
49 Abdominal Compartment Syndrome
Abstract
Intraabdominal Hypertension
Abdominal Compartment Syndrome
Mitigation Strategies
Future Directions
Key Points
References
50 Hemolytic Uremic Syndrome
Abstract
Definition
Laboratory Exams
STEC-HUS
Atypical HUS
Acknowledgments
Key Points
References
Section 11 Prevention and Treatment: General Treatment Concepts
51 Nonpharmacologic Management of Acute Renal Injury
Abstract
Risk Assessment and Early Diagnosis of Acute Kidney Injury
Adequate Volume and Hemodynamic Status
Minimizing Nephrotoxin Exposure
Conclusion
Key Points
References
52 Novel Drugs for Acute Kidney Injury
Abstract
Novel Therapies for Prerenal Disease
Novel Therapies for Intrinsic Disease
Conclusion
Key Points
References
53 Remote Ischemic Preconditioning
Abstract
Potential Mechanisms of Protection
Clinical Trials
Future of Remote Ischemic Preconditioning
Conclusion
Key Points
References
Section 12 Fluid and Electrolytes
54 Blood Biochemistry
Abstract
Key Points
References
55 Assessment of Urine Biochemistry
Abstract
Urine Sodium
Fractional Excretion of Urea
Urine Chloride
Urine Osmolality
Urine Specific Gravity
Urine Potassium
Urine Anion Gap and Urine Osmolal Gap
Other Urine Electrolytes
Conclusion
Key Points
References
56 Disorders of Sodium and Water Balance
Abstract
Serum Sodium Concentration
Overview of Sodium and Water Balance
Hyponatremia
Patient With Severe Cerebral Symptoms
Measures to Avoid Overcorrection of Hyponatremia
Mechanisms Causing Hyponatremia and Lasting Correction
Hypernatremia
Conclusion
Key Points
References
57 Disorders of Potassium and Magnesium
Abstract
Physiologic Role of Potassium
Regulation of Potassium
Hypokalemia
Hyperkalemia
Physiologic Role of Magnesium
Regulation of Magnesium
Hypomagnesemia
Hypermagnesemia
Conclusion
Key Points
References
58 Calcium and Phosphate Physiology
Abstract
Calcium Metabolism and Handling
Phosphorus Metabolism and Handling
Physiology of Vitamin D
Conclusion
Key Points
References
59 Principles of Fluid Therapy
Abstract
Physiologic Rationale for Fluid Administration
Volume, Rate, and End Point of Fluid Administration
Selection of Fluid
Conclusion
Key Points
References
60 Blood Transfusion Therapy
Abstract
Blood Components
Evidence-Based Blood Component Therapy
Conclusion
Key Points
References
61 Loop and Thiazide Diuretics
Abstract
Loop Diuretics
Pharmacokinetics
Diuretic Responsiveness and Resistance
Continuous Versus Intermittent Administration
Key Points
References
62 Vaptans and the Treatment of Hyponatremia
Arginine Vasopressin and Vaptans
Key Points
References
63 Aldosterone Antagonists, Amiloride, and Triamterene
Aldosterone Antagonists
Eplerenone
Nonaldosterone Antagonist Potassium-Sparing Diuretics
Conclusion
Key Points
References
Section 13 Acid-Base
64 Laboratory Tests
Abstract
Blood Gas Variables: Measured and Calculated
Interpretation of the Gaps
Key Points
Acknowledgement
References
65 Acid-Base Physiology and Diagnosis of Disorders
Abstract
Conventional Comprehensive Acid-Base Model
Charge-Balance Based Modeling of Acid-Base
Exploring the Utility of the Charge-Balance Model to Understand Acid-Base
Practical Approach
Key Points
References
66 Metabolic Acidosis
Abstract
Brief Review of the Quantitative Approach
Effects of Acidosis in Human Physiology
Therapeutic Considerations
Conclusion
Key Points
References
67 Hyperlactatemia and Lactic Acidosis
Abstract
Normal Metabolism of Lactate and Physiologic Hyperlactatemia During Exercise
Pathophysiology of Hyperlactatemia in Critical Illness
Diagnostic Considerations
Blood Lactate Level and Prognosis
Conclusion
Key Points
References
68 Renal Tubular Acidosis
Abstract
Definition
Types of Renal Tubular Acidosis
Pathophysiology of Renal Tubular Acidosis
Diagnosis of Renal Tubular Acidosis
Treatment
Key Points
References
69 Metabolic Alkalosis
Abstract
Definition of Alkalinity and Alkalosis
Pathophysiology of Metabolic Alkalosis
Key Points
References
70 Respiratory Acid-Base Disorders
Abstract
Pathophysiology of the Control of Breathing
Compensatory Mechanisms
Causes of Respiratory Acid-Base Disorders
Signs and Symptoms of Respiratory Acid-Base Disorders
Therapeutic Options
Key Points
References
71 Iatrogenic and Poison-Derived Acid Base Disorders
Specific Disturbances
Conclusion
Key Points
References
Section 14 Metabolism and Nutrition in Critical Illness and Acute Kidney Injury
72 Energy Requirement and Consumption in the Critically Ill Patient
Metabolic Response to Critical Illness
Measurement Methods
Estimation of Energy Expenditure
Energy Requirement Versus Energy Consumption
Key Points
References
73 Impact of Renal Replacement Therapy on Metabolism and Nutrient Requirements in the Critically Ill Patient
Abstract
Intermittent Renal Replacement Therapy, Intermittent Hemodialysis, Hemodiafiltration, and Slow-Efficiency Extended Hemodialysis
Metabolic Effects of Continuous Renal Replacement Therapy Modalities
Conclusion
Key Points
References
74 Amino Acid Turnover, Protein Metabolism, and Nitrogen Balance in Acute Kidney Injury
Abstract
Nitrogen, Amino Acids, and Protein Balance
Protein and Muscle Turnover
Protein Energy Wasting and Muscle Wasting in Critical Illness and Acute Kidney Injury
Amino Acid and Nitrogen Balance in Acute Kidney Injury and Renal Replacement Therapy
Other Nutrient Balance Affecting Protein or Muscle Turnover
Implications on Nutritional Management
Key Points
References
75 Carbohydrates and Lipids
Abstract
Carbohydrate Metabolism
Lipid Metabolism
Conclusion
Key Points
References
76 Endocrinology of the Stress Response During Critical Illness
Abstract
Stress Response
Stress Hyperglycemia
Stress Hyperlactemia
Conclusion
Key Points
References
77 Anemia of Critical Illness
Abstract
Definition of Anemia
Epidemiology
Cause of the Anemia of Critical Illness
Conclusion
Key Points
References
78 Management of Nutrition in Acute Kidney Injury and Renal Replacement Therapy
Abstract
Metabolic Environment and Nutritional Requirements in Acute Kidney Injury
Practical aspects of artificial nutrition in AKI
Key Points
References
79 Blood Glucose Control in Critical Care
Abstract
Stress-Induced Hyperglycemia
Normoglycemia in Critically Ill Patients
Other Key Studies of Glucose Control and Insulin Therapy
Blood Glucose Control and Acute Kidney Injury
Blood Glucose Control and Infections
Blood Glucose Control and Nutritional Support
Incidence of Hypoglycemia Related to Lowering Blood Glucose Control
Variability (Fluctuation) of Blood Glucose Control in Critically Ill Patients
Recent Recommendations for Blood Glucose Control in the Critically Ill
Conclusion
Key Points
References
80 Enteral Nutrition
Preference for Enteral Nutrition
Potential Risks Associated With Enteral Feeding
Reducing the Risks of Enteral Nutrition
Choosing the Optimal Enteral Nutrition Product
Issues Specific to the Critically Ill Renal Failure Patient
Conclusion
Key Points
References
Section 15 Infectious Diseases and Sepsis
81 Microbiologic Considerations in the Intensive Care Patient
Epidemiology of Infections in the Intensive Care Unit
Systemic Manifestation of Infection in the Intensive Care Unit
Multi-Drug–Resistant Organisms in the Intensive Care Unit
Antimicrobial Stewardship in the Intensive Care Unit
Strategies to Decrease Infections in the Intensive Care Unit
Immunosupression in the Intensive Care Unit
Key Points
References
82 Innate Immunity and the Kidney
Abstract
A Brief History of Discoveries of the Innate and Adaptive Host Immune Responses
Introduction Into Innate Immunity
Cellular and Humoral Components of Host Innate Immune Defenses
Resolution of Inflammation and Deactivation of Innate Immune Responses
Conclusion
Key Points
References
83 Adaptive Immunity and Critical Illness
Abstract
Immune System: an Overview
Recognition of Foreign Molecules
Innate Immune Response
Activation of the Adaptive Immune Response
Adaptive Immune Response in Acute Kidney Injury
Septic Acute Kidney Injury
Ischemic Acute Kidney Injury
Nephrotoxic Acute Kidney Injury
Resolution of Inflammation
Chronic Kidney Disease
Key Points
Key References
84 Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome
Abstract
Pathogenesis of Spontaneous Bacterial Peritonitis
Clinical Manifestations and Diagnosis of Spontaneous Bacterial Peritonitis
Pathogenesis of Hepatorenal Syndrome in Patients With Spontaneous Bacterial Peritonitis
Treatment of Spontaneous Bacterial Peritonitis
Key Points
References
85 Tropical Infections Causing Acute Kidney Injury
Tropical Infections Associated With Acute Kidney Injury and “One Health” Perspective
Role of Renal Replacement Therapy in Tropical Infections Causing Acute Kidney Injury
Long-Term Renal Outcome After Tropical Infections Causing Acute Kidney Injury
Key Points
References
86 Sepsis and Septic Shock
Limitations of Sepsis-1 and Sepsis-2
Definitions Versus Clinical Criteria
Sepsis-3 Definition of Sepsis
Sepsis-3 Definition of Septic Shock
Clinical Criteria to Identify Patients Likely to Have Sepsis
Clinical Criteria for Septic Shock
Concerns, Controversies, and Limitations
Conclusion
Key Points
References
87 Complement and Its Consequences in Sepsis
Abstract
Complement Activation Products in Plasma During Sepsis
Neutralizing Antibodies to Rat and Mouse C5a
Pathophysiologic Events Involving Complement During Sepsis
Role of Complement in Acute Lung Injury; Similarities to Events in Sepsis
Novel Form of Complement Activation
Key Points
References
88 Coagulation Abnormalities in Sepsis
Abstract
Normal Coagulation
Coagulation in Sepsis
Decreased Coagulation Factor Production and Increased Coagulation Factor Destruction in Sepsis
Thrombocytopenia in Sepsis
Prothrombotic State of Sepsis
Disseminated Intravascular Coagulation
Sepsis-Associated Coagulopathy as a Marker of Endothelial Injury
Interaction of Coagulation and Inflammation in Sepsis
Diagnosis of Sepsis-Associated Coagulopathy: the Spectrum of Coagulopathy in Sepsis
Clinical Presentation of Sepsis-Associated Coagulopathy
Frequency of Sepsis-Associated Coagulopathy
Outcomes of Sepsis-Associated Coagulopathy
Therapeutics Aimed at Sespsis-Associated Coagulopathy That Also May Modulate Inflammation
Current SAC-Targeted Drugs in Development: Recombinant Human Thrombomodulin
Clinical Practice Recommendations
Conclusion
Key Points
References
89 Endothelial Dysfunction of the Kidney in Sepsis
Abstract
Role of Renal Endothelium in Function
Endothelial Cells and the Pathophysiology of Sepsis
Translation of Endothelium Damage Into a Loss of Kidney Function
Therapies Targeting Renal Ecs in Sepsis-Induced Acute Kidney Injury
Conclusion
Key Points
References
90 Sepsis-Induced Acute Kidney Injury
Abstract
Definition of Acute Kidney Injury in the Clinical Setting
Epidemiology of Sepsis-Induced Acute Kidney Injury
Novel Concepts in the Pathophysiology of Sepsis-Induced Acute Kidney Injury
Conclusion
Key Points
References
91 Recommendations for Sepsis Management
Abstract
Definitions
Antibiotics Administration
Steroids in the Treatment of Sepsis
Resuscitation End Points
Key Points
References
92 Principles of Antimicrobial Prescription in Intensive Care Unit Patients With Acute Kidney Injury
Abstract
Description of Antimicrobial Prescribing Practices in the Intensive Care Unit
Considerations Regarding Antmicrobial Therapy and Acute Kidney Injury
Therapeutic Drug Monitoring
Antimicrobial Dosing Recommendations
Summary
Key Points
References
93 Renal Replacement Therapy for Septic Acute Kidney Injury
Abstract
Mode of Renal Replacement Therapy
Dose of Renal Replacement Therapy
Filter Membranes
Timing of Renal Replacement Therapy
Summary
Key Points
References
94 Blood Purification for Sepsis
Abstract
Mechanisms of Blood Purification in Sepsis
Purification Technologies and Their Evaluation in Sepsis
Indication and Intervention Outcomes
Conclusion
Key Points
References
95 Management of Infection in Patients With Kidney Transplant
Abstract
Timeline of Infection After Kidney Transplantation
Specific Infections: Presentation and Treatment
Central Nervous System Syndromes
Human Immunodeficiency Virus and Renal Transplant
Key Points
References
96 Critical Care Viral Infections
Abstract
Central Nervous System Infections
Respiratory Viral Illness
Gastrointestinal Illness
Key Points
References
97 Principles of Antibiotic Prescription in Intensive Care Unit Patients and Patients With Acute Renal Failure
Pathogens of Concern: Multi-Drug–Resistant Organisms
Treatment
Epidemiology of Antibiotic Resistance in the Intensive Care Unit
Mechanisms for Antibiotic Resistance
Prevention
Conclusion
Key Points
References
Section 16 Acute Intoxication and Poisoning
98 Drugs and Antidotes in Acute Intoxication
Abstract
Toxidromes
Specific Poisons and Antidotes
Some Renal Considerations
Conclusion
Key Points
References
99 Extracorporeal Therapies in Acute Intoxication and Poisoning
Abstract
Criteria for Consideration of Extracorporeal Therapy
Hemodialysis
Hemoperfusion
Use of Chelating Agents With Extracoporeal Modalities
Intoxication With Specific Agents
Key Points
References
100 Plasmapheresis in Acute Intoxication and Poisoning
Abstract
Mechanisms of Action
Technical Overview
Comparisons With Other Extracorporeal Detoxification Methods
Pharmacokinetic Considerations
Limitations of Published Reports
Efficacy of Plasmapheresis in Specific Intoxications
Efficacy of Plasmapheresis in Specific Drug Overdose
Summary
Key Points
References
101 Poisoning
Some Basic Principles of Pharmacokinetics
Differences Between Pharmacokinetics and Toxicokinetics
Management of Poisoning
General Supportive Treatment
Extracorporeal Life Supportive Treatment
Conclusion
Key Points
References
Section 17 Acute Kidney Injury and Organ Crosstalk
102 Bleeding and Hemostasis in Acute Renal Failure
Abstract
Physiologic Hemostasis
Pathophysiology
Conclusion
Key Points
References
103 Gastrointestinal Problems in Acute Kidney Injury
Abstract
Pathogenesis of Uremic Lesions in the Gastrointestinal Tract
Gastrointestinal Problems Commonly Associated With Acute Renal Failure
Gastrointestinal Tract–Related Acid-Base and Electrolyte Disturbances Associated With Acute Renal Failure
Drug-Prescribing Guidelines in Acute Renal Failure
Key Points
References
104 Cardiovascular Problems in Acute Kidney Injury
Abstract
Cardiovascular Complications in Chronic Kidney Disease
Cardiovascular Complications in Acute Kidney Injury
Pathophysiology of Cardiopulmonary Dysfunction in Acute Kidney Injury
Direct Effects of Renal Replacement Therapy on Cardiovascular Complications
Conclusion
Key Points
References
105 Water and Electrolyte Disturbances in Acute Renal Failure
Abstract
Hyperkalemia
Hyponatremia
Hypernatremia
Disorders of Calcium and Phosphate Balance
Key Points
References
106 Neurologic Problems in Acute Renal Failure
Abstract
Basic Pathophysiology of the Brain in Acute Renal Failure
Infections Causing Acute Renal Failure and Cerebral Dysfunction
Vascular Diseases Causing Acute Renal Failure Causing Cerebral Dysfunction
Electrolyte Imbalance in Acute Renal Failure Causing Cerebral Dysfunction
Metabolic Disorders Causing Cerebral Dysfunction With Acute Renal Failure
Drugs Causing Acute Brain and Kidney Injury
Conclusion
Key Points
References
107 Immunologic and Infectious Complications of Acute Kidney Injury
Abstract
Epidemiology of Infection in Patients With Acute Kidney Injury
Pathogenesis of Infection in Patients With Acute Kidney Injury
Conclusion
Key Points
References
108 Cellular Response to Acute Kidney Injury
Abstract
Acute Kidney Injury as a Systemic Disease
Acute Kidney Injury and Cytokines
Acute Kidney Injury, Cytokines, and the Lungs
Acute Kidney Injury, Cytokines, and the Heart
Acute Kidney Injury, Cytokines, and the Brain
Acute Kidney Injury, Cytokines, and the Gastrointestinal Tract
Experimental Acute Kidney Injury and Cytokine Homeostasis
Acute Kidney Injury and Impaired Neutrophil Function
Summary
Key Points
References
Section 18 Interaction of the Heart and the Kidney
109 Heart-Kidney Cross-Talk
Abstract
Predisposing Factors
Subclinical Acute Kidney Injury
Cardiac and Renal Fibrosis
Hemodynamics and Congestion
Neurohormonal Activation
Hypothalamic-Pituitary Stress Reaction
Inflammation and Immune Cell Signaling
Subclinical Endotoxemia
Concurrent Infection
Complications of Medical Therapy
Oxidative Stress as Result of Heart Kidney Cross-Talk
Counterregulatory Mechanisms
Conclusion
Key Points
References
110 Classification of Cardiorenal Syndrome
Abstract
Definition of Cardiorenal Syndrome
Cardiorenal Syndrome Type – 1 (Acute Cardiorenal Syndrome)
Cardiorenal Syndrome Type – 2 (Chronic Cardiorenal Syndrome)
Cardiorenal Syndrome Type – 3 (Acute Renocardiac Syndrome)
Cardiorenal Syndrome Type – 4 (Chronic Renocardiac Syndrome)
Cardiorenal Syndrome Type – 5
Key Points
References
111 Cardiorenal Syndrome Type 1
Epidemiology
Risk Factors and Patient's Susceptibility
Pathophysiology
Acute Pathways of Cardiorenal Syndrome Type 1
Treatment
Conclusion
Key Points
References
112 Cardiorenal Syndrome Type 2
Abstract
Epidemiology of Cardiorenal Syndrome Type 2
Pathogenesis
Diagnosis and Biomarkers
Management
Over the Horizon
Conclusion
Key Points
References
113 Cardiorenal Syndrome Type 3
Abstract
Animal Models
Human Studies
Short-Term Outcomes
Conclusion
Key Points
References
114 Cardiorenal Syndrome Type 4
Abstract
Definition and Epidemiology
Cardiovascular Disease in Chronic Kidney Disease
Assessment and Management of Cardiovascular Risks in Chronic Kidney Disease
Conclusion
References
115 Cardiorenal Syndrome Type 5
Abstract
Pathogenesis of Cardiorenal Syndrome Type 5
Diagnosis of Cardiorenal Syndrome Type 5
Management of Cardiorenal Syndrome Type 5
Key Points
References
116 Renal Function During Cardiac Mechanical Support and Artificial Heart
Abstract
Indications and Types of Mechanical Cardiac Supports
Patterns of Use of Ventricular-Assist Device
Complications
Key Points
References
117 The Kidney in Diastolic Dysfunction
Pathophysiology and Hemodynamics in Diastolic Dysfunction
From Heart to Kidney and the Cardiorenal Syndromes
Key Points
References
118 Principles of Diuretic Management in Heart Failure
Abstract
Consequences of Extracellular Fluid Volume Expansion
Physiologic Response to Diuretics
Influence of Heart Failure on Diuretic Responsiveness
Influence of Chronic Kidney Disease on Diuretic Management
Benefits of Diuretics in Heart Failure
Negative Effects of Diuretics in Heart Failure
Diuretic Management
Beyond Diuretics
Summary
Key Points
References
119 Management of Overhydration in Heart Failure Patients
Abstract
Diuretics
Conclusion
Key Points
References
120 Recent Advances for Stroke Prevention in Patients With Atrial Fibrillation and Advanced Kidney Disease
Abstract
Novel Oral Anticoagulants and Chronic Kidney Disease
Conclusion
Key Points
References
Section 19 Interaction of the Lung and Kidney
121 Lung-Kidney Cross-Talk
Abstract
Alveolar-Capillary Barrier as a Functional Unit
Acute Kidney Injury and the Lung
Key Points
References
122 The Kidney During Mechanical Ventilation
Abstract
Mechanical Ventilation Versus Spontaneous Breathing
Indications for Mechanical Ventilation
Ventilator-Induced Lung Injury
Mechanical Ventilation and the Kidney
Biotrauma and the Kidney
Conclusion
Key Points
References
123 Extracorporeal Membrane Oxygenation and Renal Function
Abstract
Extracorporeal Membrane Oxygenation
Acute Kidney Injury in Extracorporeal Membrane Oxygenation Patients
Pathophysiology of Acute Kidney Injury in Extracorporeal Membrane Oxygenation Patients
Hemodynamics
Coagulation and Systemic Inflammation
Organs Cross-Talk
Renal Replacement Therapy During Extracorporeal Membrane Oxygenation
Conclusion
Key Points
References
124 Extracorporeal Carbon Dioxide Removal
Abstract
From Renal to Respiratory Dialysis (Historical Perspective)
Carbon Dioxide Physiology
Technical Description of Extracorporeal Carbon Dioxide Removal Systems
Clinical Applications of Extracorporeal Carbon Dioxide Removal
Chronic Obstructive Pulmonary Disease
Patients With Acute Kidney Injury Who Require Renal Replacement Therapy
Complications of Extracorporeal Carbon Dioxide Removal
Conclusion
Key Points
References
125 Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy in Adults and Children
Abstract
Current Practice, Modality, and Indications
Impact of Renal Function and Renal Replacement Therapy on Outcome During Extracorporeal Membrane Oxygenation
Conclusion
Key Points
References
126 Pulmonary-Renal Syndrome
Immunopathogenesis of Immune-Mediated Pulmonary-Renal Syndromes
Antineutrophil Cytoplasmic Antibody–Associated Vasculitis
Anti–glomerular Basement Membrane Disease (Goodpasture Disease)
Immune Complex–Mediated Pulmonary-Renal Syndrome
Diagnostic Approach to Pulmonary-Renal Syndrome
Nonimmune Causes of Pulmonary Disease in Patients With Renal Disease
Principle Diseases Causing Pulmonary-Renal Syndrome: Clinical Features and Management
Antineutrophil Cytoplasmic Antibody–Associated Vasculitis
Key Points
References
Section 20 The Liver and the Kidney
127 Liver-Kidney Interaction
Abstract
Role of Ammonia and Glutamine
Ureagenesis
Alternative Approach
Regulatory Role of Hepatocyte Heterogeneity
Acid-Base Balance in Hepatic Functional Impairment
Key Points
References
128 Pathophysiology and Management of the Hepatorenal Syndrome
Abstract
Diagnostic Criteria of Hepatorenal Syndrome
Pathophysiology of Hepatorenal Syndrome
Prophylaxis of Hepatorenal Syndrome
Management of Hepatorenal Syndrome
Key Points
References
129 Kidney Dysfunction After Liver Transplantation
Abstract
Assessment of Renal Function Before and After Liver Transplantation
Risk Factors for Early Postoperative Acute Kidney Injury After Orthotopic Liver Transplantation
Factors Affecting Renal Dysfunction in Long-Term Survivors After Orthotopic Liver Transplantation
Conclusion
Key Points
References
130 Extracorporeal Liver Support Devices
Abstract
Artificial Systems
Conclusion
Key Points
References
Section 21 Interaction of the Brain and the Kidney
131 Treatment of Combined Acute Renal Failure and Cerebral Edema
Basic Pathophysiology of Cerebral Edema
Patients at Risk of Cerebral Edema
Supportive Management of Patients With Cerebral Edema
Choosing Renal Support for the Patient With Cerebral Edema
Prescribing Renal Support for Patients With Cerebral Edema
Conclusion
Key Points
References
132 Renal Protection in the Organ Donor
Abstract
Medical Suitability
Brain Death and Physiologic Sequelae
Management of the Brain-Dead Potential Organ Donor
Donation After Circulatory Death
Conclusion
Key Points
References
133 Effect of Extracorporeal Therapies on the Brain
Effect of Hemodialysis and Peritoneal Dialysis on the Brain (Chronic Setting)
Hemodialysis and Peritoneal Dialysis on Stroke
Hemodialysis and Peritoneal Dialysis on Cognitive Function
Dialysis Adequacy and Cognitive Function
Dialysis Disequilibrium Syndrome
Acute Defects in Cognition
Effect of Continuous Renal Replacement Therapy on the Brain (Acute Setting)
Effect of Extracorporeal Membrane Oxygenation on the Brain
Conclusion
Key Points
References
Section 22 Fluid Balance and its Management in the Critically Ill
134 Components of Fluid Balance and Monitoring
Abstract
Normal Physiology
Role of Diuretics and Ultrafiltration in Acute Kidney Injury
Practical Issues and Conclusion
Key Points
References
135 Noninvasive Methods of Fluid Status Assessment in Critically Ill Patients
Abstract
Physical Examination and Fluid Balance Recording
Chest Radiography
Bioelectrical Impedance Analysis
Ultrasonography Techniques
Conclusion
Key Points
References
136 Management of Fluid Overload in Cardiorenal Patients
Five Bs
Conclusion
Key Points
References
137 Mechanical Fluid Removal
Abstract
Rationale for Mechanical Fluid Removal
Conclusion
Key Points
References
Section 23 General Principles of Acute Renal Replacement Therapy
138 Indications for Renal Replacement Therapy in the Critically Ill
Renal Indications
Nonrenal Indications
Conclusion
Key Points
References
139 Principles of Extracorporeal Circulation and Transport Phenomena
Abstract
Principles of Extracorporeal Circulation
Transport Phenomena
Conclusion
Key Points
References
140 Membranes and Filters for Use in Acute Renal Failure
Abstract
History and Evolution of Filters and Membranes
Performance Parameters
Classification of Membranes and Filters
Factors Influencing Treatment Performance
Selection of Filters and Membranes
Future Developments
Conclusion
Key Points
References
141 Continuous Renal Replacement Therapy Machine Technology
Abstract
Continuous Renal Replacement Therapy Machines: Historical Perspective
Continuous Renal Replacement Therapy Hardware
Continuous Renal Replacement Therapy Disposables
Conclusion
Key Points
References
142 Principles of Anticoagulation in Extracorporeal Circuits
Abstract
Anticoagulation Intermittent Hemodialysis Heparin Clotting Membrane
Anticoagulation Techniques for Intermittent Hemodialysis
Conclusion
Key Points
References
143 Dialysis Solutions and Replacement Fluids
Sodium and Potassium
Buffer
Citrate
Phosphorus
Magnesium
Continuous Renal Replacement Therapy Solutions and Energy Balance
Conclusion
Key Points
References
144 Starting and Stopping Renal Replacement Therapy in the Critically Ill
Abstract
Predictors for Dialysis Requirement
Blood Urea Nitrogen
Creatinine and Creatinine Clearance
Urine Output
Fluid Balance
Hyperkalemia
Acidosis
Platelet Dysfunction
Uremic Encephalopathy and Neuropathy
Renal Replacement Therapy for Multisystem Organ Failure
Renal Support Versus Renal Replacement
Timing of Initiation
Scoring Systems to Guide Renal Replacement Therapy
Discontinuing Renal Replacement Therapy
Withholding and Withdrawing Therapy
Conclusion
Key Points
References
145 The Concept of Renal Replacement Therapy Dose and Efficiency
Abstract
Efficiency, Intensity, Efficacy: Kt/V
History of Clinical Trials on Continuous RENAL Replacement Therapy Dose
From Bench to Bedside: The Clinical Meaning of Dose
From Bench to Bedside: The Prescription
Key Points
References
146 Quantification of Acute Renal Replacement Therapy
Abstract
Clinical Dosing Targets for Acute Intermittent Hemodialysis
Clinical Dosing Targets for Continuous Renal Replacement Therapy
Calculation of Fractional Clearance for Intermittent Hemodialysis
Calculation of Indexed Solute Clearance for Continuous Renal Replacement Therapy
Unified Expressions of Dose for Acute Renal Replacement Therapy
Practical Quantification of Acute RENAL Replacement Dose Using Corrected Equivalent Renal Urea Clearance
Conclusion
Key Points
References
147 Principles of Pharmacodynamics and Pharmacokinetics of Drugs Used in Extracorporeal Therapies
Abstract
Factors Affecting Drug Clearance During Renal Replacement Therapy
Principles for Dosage Adjustments During Continuous Renal Replacement Therapy
Pharmacodynamics and Dosage Adjustments of Antimicrobial Agents During Renal Replacement Therapy
Conclusion
Key Points
References
148 Ethical Considerations in Acute Renal Replacement Therapy
Abstract
Renal Replacement Therapy in the Care of the Critically Ill Patient
Biosocial Aspects of Renal Replacement Therapy
Key Points
References
Section 24 Intermittent Renal Replacement Therapies
149 Intermittent Techniques for Acute Dialysis
Abstract
Physical Principles
Key Points
References
150 Solute and Water Transport in Hemodialysis
Abstract
Diffusion and Convection
Membranes and Filters for Intermittent Hemodialysis
Characterization of Dialyzer Performance: Clearance and Ultrafiltration Coefficient
Determinants of Diffusive Solute Clearance
Internal Filtration and Backfiltration
Conclusion
Key Points
References
151 Biocompatibility of the Dialysis System
Abstract
Dialysis Membranes and Determinants of Biocompatibility
Dialysate and Infusate
The Hemodialysis Circuit as a Possible Source of Toxins: Leachables and Sterilization Process
The Effect of Dialysis Membranes on Patients' Outcomes in AKI
Key Points
References
152 Composition of Hemodialysis Fluid
Abstract
Dialysate Components
Conclusion
Key Points
References
153 Indications for and Contraindications to Intermittent Hemodialysis in Critically Ill Patients
Operational Characteristics of Intermittent Hemodialysis and Hemofiltration
Intermittent Hemodialysis and Continuous Renal Replacement Therapy: Is One Better Than the Other?
Situations in Which Intermittent Hemodialysis Should Be Preferred
Situations in Which Intermittent Hemodialysis Should Be Avoided
Conclusion
Key Points
References
154 Technical and Clinical Complications of Intermittent Hemodialysis in the Intensive Care Unit
Abstract
Technical Complications
Clinical Complications
Miscellaneous Complications
Key Points
References
155 Correction of Water, Electrolyte, and Acid-Base Derangements by Hemodialysis and Derived Techniques
Abstract
Sodium Abnormalities
Potassium Abnormalities
Abnormalities of Divalent Ions
Acid-Base Abnormalities
Conclusion
Key Points
References
156 Urea Kinetics, Efficiency, and Adequacy of Hemodialysis and Other Intermittent Treatments
Abstract
Goals of Dialysis
How to Measure the Dose
Urea Modeling
Modeling Protein Catabolism
Online Methods
Dialysis Efficiency
Timing of Dialysis Initiation
Solute Dysequilibrium: an Impediment to Delivering an Adequate Dose
Limitations of Kt/V
Minimum Dose, Frequency, and Treatment Time
Patient Size and Urea Volume: Impediments to Dialysis?
Hemodialysis Versus Hemofiltration
Accounting for Residual Clearance
Drug Dosing During and Between Treatments
Simplified Methods
Other Benchmarks of Adequacy
Conclusion
Key Points
References
157 Assessment of Fluid Status and Body Composition and Control of Fluid Balance With Intermittent Hemodialysis in the Critically Ill Patient
Body Composition in Health and Disease
Evaluation of Fluid Status and Body Composition
Intermittent Hemodialysis in the Critically Ill Patient: Control of Fluid Balance and Prevention of Intradialytic Hypotension
Key Points
References
158 Outcomes of Intermittent Hemodialysis in Critically Ill Patients With Acute Kidney Injury
Vascular Access
Selection of the Membrane
Dose of Dialysis in Intermittent Hemodialysis
Comparison of Outcomes Between Intermittent Versus Continuous Dialysis Modalities
Hemodynamic Stability
Impact of Intermittent Hemodialysis Versus Continuous Renal Replacement Therapy on De Novo Chronic Kidney Disease and Progression to End-Stage Renal Disease
Contraindications to Intermittent Hemodialysis
Summary and Conclusions
Key Points
References
159 Hybrid Dialysis Techniques in the Intensive Care Unit
Technical Issues
Clinical Outcomes
Comparative Clinical Outcomes
ICU Length of Stay
Hemodynamics
Renal Recovery
Mortality
Introducing Hybrid Therapies (HTs)
Conclusion
Key Points
References
160 The Role of Plasmapheresis in Critical Illness
Abstract
Techniques of Plasmapheresis
Thrombotic Microangiopathies
Liver Failure
Neurologic Disorders
Renal Disorders
Sepsis With Multi-Organ Failure
Conclusion
Key Points
References
161 Cascade Filtration for ABO Incompatible Transplant
Abstract
Barrier of ABO
Techniques for Antibody Removal
Cascade Filtration
Conclusion
Key Points
References
162 Nursing Issues and Procedures in Continuous Renal Replacement Therapy
Nursing Knowledge and Acute Kidney Injury
Group One Lectures
Group Two Tutorials and Practical One
Group Three Tutorials and Practical Two
Certification and Continuous Renal Replacement Therapy
Continuous Renal Replacement Therapy Machines
Protocols and Documents for Continuous Renal Replacement Therapy
Anticoagulation
Quality
Multidisciplinary Team
Advanced Therapy
Conclusion
Key Points
References
Section 25 Continuous Renal Replacement Therapies (CRRT)
163 Indications for Continuous Renal Replacement Therapy
Abstract
Traditional Indications for Continuous Renal Replacement Therapy: Renal Indications
Renal Replacement Versus Renal Support
Nonrenal Indications for Continuous Renal Replacement Therapy
Conclusion
Key Points
References
164 Beginning and Ending Continuous Renal Replacement Therapy in the Intensive Care Unit
Abstract
Defining the Timing of Initiation of Continuous Renal Replacement Therapy
Rationale for When to Start Continuous Renal Replacement Therapy
Recent Clinical Studies of Timing of Continuous Renal Replacement Therapy
Rationale for When to Stop Continuous Renal Replacement Therapy
Conclusion
Key Points
References
165 Solute and Water Kinetics in Continuous Therapies
Abstract
Transport Mechanism
Continuous Renal Replacement Therapy Techniques
Additional Considerations in the Delivery of Continuous Renal Replacement Therapy
Conclusion
Key Points
References
166 Continuous Renal Replacement Therapy
Principles of Solute Removal
Continuous Renal Replacement Therapy
Conclusion
Key Points
References
167 Vascular Access for Acute Renal Replacement Therapy
Abstract
Catheter Characteristics: Material, Geometry, and Design
Methods of Central Venous Catheters Insertion
Indications and Venous Site Choice Preferences for Central Venous Catheters
Maintenance and Care of Catheters
Catheter Performance
Outcomes and Complications
Perspectives
Conclusion
Key Points
References
168 Anticoagulation Strategies for Continuous Renal Replacement Therapy
Nonanticoagulant Measures to Reduce Filter Clotting
Systemic Anticoagulation
Recommendations
Key Points
References
169 Nursing Strategies to Prevent Coagulation of the Extracorporeal Circuit
Clotting: Where and How?
Anticoagulants
Access Catheter and Site
Blood Pump–Flow Speed
Membranes: Type, Size, Heparin Coating
Fluid Administration—Predilution
Venous Chamber
Training, Education, and the Multidisciplinary Team
Conclusion
Key Points
References
170 Adequacy of Continuous Renal Replacement Therapy
Abstract
Use of Clearance to Quantify Dose in Renal Replacement Therapy
Quantification of Renal Replacement Therapy Dose in Acute Kidney Injury Versus End-Stage Renal Disease: Important Distinctions
Use of Urea Kinetics to Estimate Continuous Renal Replacement Therapy Dose
Continuous Renal Replacement Therapy Dose and Outcome Studies
Prescribed Versus Delivered Continuous Renal Replacement Therapy Dose
Modality Considerations for Continuous Renal Replacement Therapy Dose
Reconciling Effluent-Based and Clearance-Based Dose
Summary
Key Points
References
171 High-Volume Hemofiltration in the Intensive Care Unit
Abstract
Definition of High Volume
End of the Story?
Conclusion
Key Points
References
172 Pulse High-Volume Hemofiltration in Management of Critically Ill Patients With Severe Sepsis or Septic Shock
Definition and Rationale
Technical Considerations
Clinical Experience
Conclusion
Key Points
References
173 High Cutoff Membranes for Mediators Removal
Abstract
Engineering Characteristics of High Cut-off Membrane
Clinical Evidence
Conclusion
Key Points
References
174 Clinical Effects of Continuous Renal Replacement Therapies
Fluid Removal
Solute Removal, Acid-Base Control, and Electrolyte Balance
Side Effects of Continuous Renal Replacement Therapy
Trials on the Final Clinical Effect: Mortality
Potential Compromise: Hybrid Techniques
Conclusion
Key Points
References
175 Antibiotic Adjustment in Continuous Renal Replacement Therapy
Abstract
Basic Pharmacologic Parameters of Antimicrobial Agents
Pharmacokinetic Parameters
Antibiotics Classification Based on Physicochemical Properties
Antibiotics in Critical Illness
Impact of Acute Kidney Injury on Pharmacologic Characteristics of Antimicrobial Agents
Principles of Drug Removal During Renal Replacement Therapies: Technical Factors Specific to Extracorporeal Blood Purification Therapy
Rationale for Appropriate Dosage Adjustment of Antibiotics During Continuous Renal Replacement Therapy
Key Points
References
176 Nomenclature
Abstract
Characteristics of the Membrane and Filter
Mechanisms of Solute and Fluid Transport
Modalities of Extracorporeal Renal Replacement Therapy
Fluids, Volumes, and Flows
Treatment Evaluation Methods: The “Dose” of Renal Replacement Therapy
Conclusion
Key Points
References
177 Nomenclature
Abstract
Hardware and Devices
Continuous Renal Replacement Machine: Procedures and Phases of Treatment
Continuous Renal Replacement Thrapy Disposables
Volume Management and Fluid Balance
Extracorporeal Therapies and Treatments
Conclusion
List of Abbreviations
Key Points
References
Section 26 Peritoneal Dialysis in the Intensive Care Unit
178 Peritoneal Dialysis System
Peritoneal Dialysis System
Dialysate Compartment
Conclusion
Key Points
References
179 Indications, Contraindications, and Complications of Peritoneal Dialysis in Acute Renal Failure
Outcomes
Renal Recovery
Complications
Clearance of Uremic Toxins
Importance and Practicality of Tunneled Catheters
Comparison of Risks
Advantages and Disadvantages
Conclusion
Key Points
References
180 Solute and Water Transport Across the Peritoneal Barrier
Abstract
Structure of the Peritoneal Barrier and Transport Principles
Physiology of Transport: Normal Conditions
Acute Peritoneal Dialysis in the Intensive Care Unit: Special Conditions
Key Points
References
181 Choice of Peritoneal Dialysis Technique
Abstract
Continuous Versus Intermittent Techniques
Advantages of Short Dwells
Disadvantages of Short Dwells
Continuous Ambulatory Peritoneal Dialysis Schedule
Continuous-Flow Peritoneal Dialysis
Conclusion
Key Points
References
182 Correction of Fluid, Electrolyte, and Acid-Base Derangements by Peritoneal Dialysis in Acute Kidney Injury
Prescription for Acute Peritoneal Dialysis
Prescription for Acute Peritoneal Dialysis
Fluid Removal
Electrolyte Abnormalities
Acid-Base Derangements
Conclusion
Key Points
References
183 Feasibility, Efficiency, and Adequacy of Peritoneal Dialysis in Acute Kidney Injury
Abstract
Feasibility of Peritoneal Dialysis in Acute Kidney Injury
Efficiency and Adequacy of Peritoneal Dialysis in Acute Kidney Injury
Adequacy and Outcomes of Peritoneal Dialysis in Acute Kidney Injury
Overall Role of Peritoneal Dialysis in Acute Kidney Injury
Conclusion
Key Points
References
184 Clinical Results and Complications of Peritoneal Dialysis in Acute Kidney Injury
Historical Perspective
Effect on Mortality
Dialysis Adequacy
Dialysis Dose
Renal Recovery
Lactate Versus Bicarbonate-Buffered Solutions
Future Trends
Complications of Acute Peritoneal Dialysis
Conclusion
Key Points
References
185 Treatment of Peritonitis and Other Clinical Complications of Peritoneal Dialysis in the Critically Ill Patient
Abstract
Infectious Complications of Peritoneal Dialysis
Other Considerations
Key Points
References
186 Comparison of Peritoneal Dialysis With Other Treatments for Acute Kidney Injury
Abstract
Solute and Volume Control and Overall Outcomes
Cost
Dialysis Access
Potential Benefits Favoring Peritoneal Dialysis
Potential Limitations Favoring Other Modalities
Conclusion
Acknowledgments
Key Points
References
187 Continuous-Flow Peritoneal Dialysis as Acute Therapy
Abstract
Rationale and Physiology
Historical Perspective
Technique
Continuous-Flow Peritoneal Dialysis in Pediatric Acute Renal Failure
Clinical Experience With Continuous-Flow Peritoneal Dialysis in Acute Renal Failure
Advantages and Indications for Continuous-Flow Peritoneal Dialysis in Acute Renal Failure
Conclusion and Future Directions
Key Points
References
188 Nursing and Procedure Issues in Peritoneal Dialysis
Procedure
Nursing Issues in Peritoneal Dialysis
Review of Literature
Conclusion
Key Points
References
Section 27 Extracorporeal Blood Purification Techniques Beyond Dialysis
189 Sorbents
Basic Principles
Sorbent Materials and Structure
Requirements for a Sorbent
Mechanism of Solute Adsorption in Porous Media
Flow Distribution in Packed Beds
Efficiency of Adsorption
Biocompatibility of Sorbents
Rationale for the Use of Adsorption in Clinical Settings
Typical Modalities of Utilization of Sorbents
Sorbent-Based Adjunctive Therapies for Sepsis
Novel Applications of Sorbents
Conclusion
Key Points
References
190 Therapeutic Apheresis in Critically Ill Patients
Pathophysiologic Aspects of Apheresis in Critical Care Medicine
Modalities and Techniques
Indications
Clinical Results
Apheresis in Kidney Transplantation
Apheresis in Sepsis and Multi-Organ Failure
Key Points
References
191 Extracorporeal Blood Purification Techniques Beyond Dialysis
Regional Citrate Anticoagulation in Coupled Plasmafiltration-Adsorption
Conclusion
Key Points
References
192 Prometheus System
Abstract
Prometheus System
Conclusion
Key Points
References
193 Toraymyxin and Other Endotoxin Adsorption Systems
Role and Measurement of Endotoxin in Septic Patients
Therapies Against Endotoxins: From Drugs to Medical Devices
Toraymyxin System: Concept and Manufacturing Process
Clinical Experience With Endotoxin Adsorption
Measurement and Removal of Endotoxin: EUPHRATES a Theranostic Trial of PMX-DHP for Endotoxemic Septic Shock
Key Points
References
194 Plasmafiltration-Adsorption-Dialysis System
Process of Plasmafiltration-Adsorption-Dialysis
Preliminary Data From in vitro Studies
Potential Clinical Effects of Plasmafiltration-Adsorption-Dialysis
Key Points
References
195 Extracorporeal Membrane Oxygenation for Cardiac Support
Abstract
Technical Aspects
Indications for Starting and Stopping VA-ECMO
Extracorporeal Membrane Oxygenation for Cardiopulmonary Resuscitation
Conclusion
Key Points
References
196 Extracorporeal Membrane Oxygenation for Pulmonary Support
Abstract
Background
Indications
Physiology
Circuit
Monitoring and Management of Artificial Lung
Ventilatory Management of the Native Lung
Anticoagulation and Hematologic Monitoring
Extracorporeal Membrane Oxygenation Complications
Weaning From Venovenous Extracorporeal Membrane Oxygenation
Key Points
References
197 Cell-Based Therapies
Renal Tubule Assist Device
Bioartificial Kidney in Series With Renal Replacement Therapy
Leukocyte Cell Processing in situ
Clinical Assessment of the Selective Cytopheretic Device
RCA for Continuous Renal Replacement Therapy With the Selective Cytopheretic Device
Conclusion
Key Points
References
Section 28 Critical Care Nephrology in Pediatrics
198 Cellular and Molecular Mechanisms of Acute Kidney Injury
Abstract
Nephrotoxic Acute Kidney Injury
Acute Kidney Injury in Sepsis
Clinicopathologic Correlations
Systemic Injury and Organ Cross-Talk
Key Points
References
199 Epidemiology of Pediatric Acute Kidney Injury
Abstract
Pediatric Acute Kidney Injury Epidemiology: Current State of Knowledge
Acute Kidney Injury Epidemiology
Conclusion and Future Directions
Key Points
References
200 Treatment of Acute Kidney Injury in Children
Abstract
Cause
General Approach to Conservative Management
Dialytic Therapies
Conclusion
Key Points
References
201 Technical Aspects of Pediatric Continuous Renal Replacement Therapy
Abstract
Prescription
Blood Priming
Temperature Control
Blood Flow
Access
Solutions
Anticoagulation
Membranes
Conclusion
Key Points
References
202 Multiple Organ Dysfunction in the Pediatric Intensive Care Unit
Abstract
Epidemiology and Scoring Systems for Pediatric Multiple-Organ Dysfunction Syndrome
Management of Multiple Organ Dysfunction Syndrome in the Pediatric Intensive Care Unit
Key Points
References
203 Drug Dosing in Pediatric Acute Kidney Insufficiency and Renal Replacement Therapy
Estimation of Creatinine Clearance
Pharmacokinetic Alterations With Acute Kidney Insufficiency
Dosing Considerations With Renal Failure
Dosing Considerations With Renal Replacement Therapy
Therapeutic Drug Monitoring
Conclusion
Key Points
References
204 Nutrition of Critically Ill Children With Acute Renal Failure
Abstract
Assessment and Monitoring of Nutritional Status
Nutrition Timing, Approach, and Modality in Acute Kidney Injury
Energy Provision
Conclusion
Key Points
References
205 Outcome of Pediatric Acute Kidney Injury
Abstract
Hospitalized Children
Critically Ill Pediatric Patients
Critically Ill Children Who Require Renal Replacement Therapy
Neonates and Infants
Congenital Heart Disease
Long-Term Outcome With Pediatric Acute Kidney Injury
Key Points
References
206 Renal Replacement Therapy for the Critically Ill Infant
Abstract
Renal Failure and Other Indications for Renal Replacement Therapy
Peritoneal Dialysis
Intermittent Hemodialysis
Continuous Renal Replacement Therapy
Conclusion
Key Points
References
207 Neonatal Hyperammonemia and Continuous Renal Replacement Therapy
Abstract
Practical Use of Renal Replacement Therapy in Neonatal Hyperammonemia
Clearance of Pharmacologic and Nutritional Substrates by Continuous Renal Replacement Therapy in Neonatal Hypoammonemia
Key Points
References
208 Modified Ultrafiltration in Pediatric Heart Surgery
Abstract
Historical Background
Inflammatory Response to Cardiopulmonary Bypass
Modified Ultrafiltration
Key Points
Acknowledgments
References
209 Techniques and Machines for Pediatric Renal Replacement Therapy
Modalities
Prescription
Technical Aspects of Pediactric Continuous Renal Replacement Therapy
Conclusion
Key Points
References
210 Antibiotics in Critically Ill Newborns and Children
Abstract
Antibiotic Use in Critically Ill Newborns
Drug Handling in the Neonatal Age: Theoretical Considerations
Impact of Drugs in the Premature Kidney: A Complex Interplay and Risks for Renal Damage
Making the Right Choice: Help From Guidelines, Expert Opinion, and Practice
Aminoglycosides
Vancomycin
Other Antibiotic Associations
Resistant Bacteria
Choosing the Right Dose: Not an Easy Task
Adapting the Antibiotic Dose to Renal Function
In Case of Renal Replacement Therapy: Modulation of Antibiotics
Antibiotics in Dialysis: When to Decrease and When to Increase
Key Points
References
Section 29 Kidney Transplantation and Critical Care
211 Patient Selection and Pretransplantation Care for Kidney Transplant Recipients
Abstract
Referring Patients for Kidney Transplantation
Recipient Evaluation Process
Evaluating Risks to Successful Transplantation
Recurrence of Primary Renal Disease After Transplantation
Gastrointestinal Evaluation
Cardiac Evaluation
Malignancies
Organ Allocation Systems
Conclusion
Key Points
References
212 Kidney Support and Perioperative Care in Kidney Transplantation
Pretransplant Evaluation
Patient With Early Graft Dysfunction and Delayed Graft Function
Early Surgical Complications
Other Surgical Complications
Key Points
References
213 Acute Renal Failure in Kidney Transplant Recipients
Abstract
Causes and Risk Factors of Delayed Graft Function
Pathophysiology of Renal Ischemia-Reperfusion Injury
Ischemia/Reperfusion Injury Enhances Allograft Immunogenicity
Future Therapeutic Perspectives
Key Points
References
Section 30 Special Kidney Problems in the Intensive Care Unit
214 Management of Chronic Kidney Disease and End-Stage Kidney Disease Patients in the Intensive Care Unit
Abstract
Pathophysiologic Relationship Between Chronic Kidney Diseases and Acute Kidney Injury
Transition From Intermittent Hemodialysis or Peritoneal Dialysis to Continuous Renal Replacement Therapy
Transition From Continuous Renal Replacement Therapy to Intermittent Hemodialysis or Peritoneal Dialysis
Recovery From Acute Kidney Injury and Risk to Develop Chronic Kidney Disease
Conclusion
Key Points
References
215 Management of Patients with Diabetes in the Intensive Care Unit
Abstract
What Is Known and What Is Not Known
Epidemiology and Burden of Illness
Diabetic Kidney Disease: Kidneys at Risk
Treatment
Conclusion
Key Points
References
216 Diagnosis and Management of Acute Kidney Injury in the Emergency Department
Diagnostic Utility of Biomarkers
Management of Acute Kidney Injury in the Emergency Department
Key Points
References
217 Anticancer Drugs and the Kidney
Conventional Chemotherapy
Targeted and Biologic Therapy
Conclusion
Key Points
References
218 Antiinflammatory Drugs and the Kidney
Abstract
Mechanisms of Renal Damage Induced by Nonsteroidal Antiinflammatory Drugs
Clinical Disorders Associated With the Use of Nonsteroidal Antiinflammatory Drugs
Conclusion
Key Points
References
219 Calcineurin Inhibitors and Other Immunosuppressive Drugs and the Kidney
Conclusion
Key Points
References
220 Alternative Medicine and Chinese Herbs and the Kidney
Definitions
General Treatment Principles of Traditional Chinese Medicine
Mechanisms of Nephrotoxicity of Herbal Medicine
Herbs With Known Toxicity
Use of Wrong Preparation or Substitute
Contaminants and Adulterants
Drug Interactions
Other Alternative Therapies
Therapeutic Roles of Alternative Therapies in Kidney Disease
Key Points
References
221 Environment, Smoking, Obesity, and the Kidney
Environment
Smoking
Obesity
Key Points
References
222 Lead and Heavy Metals and the Kidney
Abstract
Mechanism of Heavy Metals Toxicity
Therapeutic Approach
Lead
Mercury
Cadmium
Cisplatin
Arsenic
Lithium
Other Heavy Metals
Biomarkers and Kidney Injury
Conclusion
Key Points
References
223 Statins and the Kidney
Statin Therapy in Patients With Chronic Kidney Disease
Statin Therapy to Prevent Acute Kidney Injury
Key Points
References
224 Erythropoietin Therapy in Critically Ill and Acute Kidney Injury Patients
Abstract
Anemia and Transfusion in the Intensive Care Unit
Conclusion
Key Points
References
225 Vasoactive Drugs, Renal Function, and Acute Kidney Injury
Vasopressor Drugs
Conclusion
Key Points
References
226 End Points for Clinical Trials in Acute Kidney Injury
Challenges Inherent to the Study of Acute Kidney Injury
Creatinine- and Urine Output–Based Criteria for Acute Kidney Injury Diagnosis
Acute Kidney Injury Risk Scores
Damage and Functional Biomarkers
Renal Replacement Therapy
Decline in Estimated Glomerular Filtration Rate
Death
Key Points
References
227 Hypothermia and the Kidney
Abstract
Pathophysiology of Ischemia/Reperfusion Injury and Hypothermic Protection
Deceased Donors
Postcardiac Arrest
Conclusion
Key Points
References
228 Renin-Angiotensin System Blockers and Acute Kidney Injury
Efficacy of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers in Chronic Kidney Disease
Risk of Acute Kidney Injury With Renin-Angiotensin System Blockers in Everyday Clinical Practice
Risk of Acute Kidney Injury in Clinical Trials Enrolling Chronic Kidney Disease Patients
Risk of Acute Kidney Injury in Clinical Trials Enrolling Patients With Heart Disease
Risk of Acute Kidney Injury in Dual Renin-Angiotensin System Blockade
Conclusion
Key Points
References
Index

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Claudio Ronco

Rinaldo Bellomo

John Kellum

Zaccaria Ricci