The maintenance of mean arterial pressure to prevent tissue dysoxia and conserve organ function is central to the management of the critically ill. In patients with increased capillary permeability this is often achieved by administration of large volumes…
Since the discovery of Erythropoietin in 1977 and subsequent cloning of the gene in 1985, recombinant Erythropoietin (EPO) has been widely used in the management of anemia due to cancer, chemotherapy, and chronic kidney disease. Although the endocrine…
I must admit that I have always routinely advised holding ACE/ARB prior to major surgery, given the possibility of hemodynamic instability and assumed risk of AKI due to impaired renal autoregulation when perfusion pressure is low. I’m prepared…
Renal failure occurring in the setting of acute decompensated heart failure (ADHF) is traditionally believed to be due to renal hypoperfusion from poor “forward flow”. This mechanism has intuitive appeal, and appears to be borne out by our…
The May issue of AJKD (Vol.55, No.5) had a nice supplement on TLS and AKI. Here is the link. Tumor lysis syndrome (TLS) describes a condition with significant clinical and lab abnormalities caused by rapid and massive tumor…
We have recently posted about problems using warfarin in renal patients. On a similar note, I was recently involved in the care of a 58-year-old African-American patient who presented with oliguric AKI and a supratherapeutic INR level of…
There are three commonly promoted strategies used in the treatment and prevention of AKI in rhabdomyolysis: 1) Normal saline 2) Bicarbonate containing solutions 3) Mannitol. Volume resuscitation is clearly paramount when treating rhabdo, but whether bicarbonate or mannitol…
The quest for biomarkers to accurately diagnose AKI is often analogized to ACS/myocardial infarction. Thus we have dubbed AKI biomarker investigation the “search for our troponin,” with the goal of facilitating early and accurate diagnosis of AKI that…
The Angiojet Rheolytic Thrombectomy System is a medical device currently used to re-establish blood flow in a variety of settings. Briefly, a catheter is introduced into an area of thrombosis and a saline stream is directed towards the thrombus of…
The study of AKI/ATN has relied heavily on one particular animal model: the warm ischemia-reflow model (often referred to as “ischemia-reperfusion injury”), in which one of the renal arteries is transiently ligated off for a set period of…
