Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-Acute Renal Failure

Acute Renal Failure

Pdf Summary

The presentation "Acute Kidney Injury and Kidney Support" by Dr. Rajit K. Basu focuses on understanding, diagnosing, and managing Acute Kidney Injury (AKI) in clinical settings. It highlights the multifactorial nature of AKI, emphasizing that its pervasiveness is influenced by factors such as gender, muscle mass, age, nutritional status, and more. AKI is defined as an acute onset of renal function decline within seven days, identified mainly through changes in creatinine levels and urine output.<br /><br />Diagnostic criteria for AKI are evolving, incorporating biomarkers to enhance specificity. The importance of urine monitoring as a vital indicator is stressed, as simultaneous assessment of creatinine and urine output can improve diagnostic accuracy.<br /><br />For managing AKI, several strategies are suggested:<br />- Modification of nephrotoxic agents<br />- Fluid management and adjudication<br />- Regular weight assessments<br />- Early optimization of systemic mean pressure<br /><br />Management bundles like the AKI KDIGO Management Bundle have been tested and implemented, particularly in adult surgical patients.<br /><br />When initiating Renal Replacement Therapy (RRT), common indications include acidosis, electrolyte imbalance, intoxications, fluid overload unresponsive to diuretics, and uremia. In pediatrics, a primary indication is fluid accumulation, with fluid overload percentages being critically linked to patient mortality.<br /><br />Different RRT modalities such as Continuous Renal Replacement Therapy (CRRT), Intermittent Hemodialysis (IHD), and Peritoneal Dialysis (PD) are discussed. CRRT, for example, is particularly useful for patients with cardiovascular instability or cerebral edema. The choice between diffusive and convective clearance methods in CRRT is examined, with considerations of the solute molecular weight and clearance efficiency.<br /><br />Practical considerations for RRT include ensuring hemodynamic stability, access, anticoagulation management, appropriate replacement fluids, and maintaining filter functionality. Collaboration with nephrology and careful monitoring of fluid removal are crucial.<br /><br />Overall, effective AKI management requires a high index of suspicion, accounting for potential sepsis, metabolic disturbances, and other organ dysfunctions. Proper supportive care and medication adjustments are essential to optimize patient outcomes.

Keywords

Acute Kidney Injury

Kidney Support

AKI diagnosis

renal function

creatinine levels

urine output

Renal Replacement Therapy

CRRT

nephrotoxic agents

fluid management

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