Blakeley Renal Failure and Replacement Therapies

1. Auflage 2010
ISBN: 978-1-84628-937-8
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 90 Seiten, eBook

Reihe: Competency-Based Critical Care

Increased recognition of the overlap between critical care and renal medicine, and recent advances in the understanding of acute renal failure and the application of renal replacement therapies, have brought increased attention to the nephrologist's role in the intensive care unit (ICU). This book is written to provide an approach for the resident in nephrology, at any level of training, with regards to critically ill patients. This text provides the information necessary to provide care for the nephrology patient in the ICU.

Zielgruppe

Professional/practitioner

Autoren/Hrsg.

Blakeley, Sara

Inhaltsverzeichnis

Assessment of Renal Function.- Imaging of Acute Renal Failure—A Problem-Solving Approach for Intensive Care Unit Physicians.- Drug-Induced Renal Injury.- Acute Kidney Injury.- Medical Management of Acute Renal Failure.- Acute Renal Failure in the Surgical Patient.- Rhabdomyolysis and Compartment Syndrome.- Multisystem Causes of Acute Renal Failure.- Therapeutic Plasma Exchange.- Renal Replacement Therapy.- Technical Aspects of Renal Replacement Therapy.- End-Stage Renal Disease.- Clinical Hyperkalemia and Hypokalemia.- Clinical Hyponatremia and Hypernatremia.- Clinical Metabolic Acidosis and Alkalosis.

Leseproben

"8 Multisystem Causes of Acute Renal Failure (p. 42-43)

Tim Leach

This chapter covers some of the more specialized causes of acute renal failure, which, although more likely to present to the nephrologist, could be admitted to the intensive care unit as a consequence of their illness or because of complications of their treatment.

Systemic Vasculitis

Vasculitis is the term given to in? ammation of blood vessels. Vasculitis is a rare condition, with an incidence of approximately 6 people per million (Western) population per year (1). Vessels can be classi? ed according to their size (Table 8.1) (2). Renal failure can occur in any vasculitis, but this chapter focuses on those conditions that affect renal function directly through in? ammation within the glomeruli (small vessels), rather than affecting the kidneys indirectly through a reduction of blood supply to the kidneys (large and medium vessel diseases).

Etiology

Small vessel vasculitides separate into two broad groups: those in which immune complexes are deposited within the renal glomeruli and those without evidence of deposition histologically. The latter group are termed pauci-immune; lacking (literally “few”) immune complexes. This distinction is useful for making a histological diagnosis and for estimating prognosis, but the underlying cause of these small vessel vasculitides is similar: autoimmunity.

Normally, the immune system surveys cells and tissues within the body, recognizing and ignoring cells expressing “self” antigens while attacking cells without these protective epitopes. In autoimmune conditions, the immune system does not protect cells with “self” expression. Cells are attacked and either in? amed or killed, or circulat- ing self-antigens are bound with antibody-forming immune complexes. Immune complexes are very large molecules that are often unable to pass through capillaries because of their size. They can induce local in? ammation and activate the com- plement cascade.

Presentation Symptoms Renal failure as a result of fulminant small vessel vasculitis will present acutely, and patients may be systemically unwell, requiring organ support. More often, however, there is an indolent presentation with several months of nonspeci? c symptoms and signs (Table 8.2).

Signs

Fulminant systemic vasculitis presents with the nephritic syndrome:
• Azotemia (more often with oligoanuria)
• Hypertension and edema from ? uid overload (but can present with circulatory collapse caused by vasodilation and dehydration)
• Hematuria with red cell casts
"