Acute Kidney Damage: Definition, Classification and Optimal Time of Hemodialysis

Serbian Journal of Experimental and Clinical Research

Hamzagic Nedim¹  Jovicic Biljana Popovska²  Nikolic Tomislav³  Petrovic Dejan³  Canovic Petar⁴  Jacovic Sasa⁵ 

[1] Center of Hemodialysis, Medical Center Tutin, Tutin, Serbia;Clinic of Infectious Diseases, Clinical center Kragujevac, Kragujevac, Serbia;Clinic of Urology, Nephrology and Dialysis, Clinical center Kragujevac, Kragujevac, Serbia;Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia;Medicines and Medical Devices Agency of Serbia, Belgrade, Serbia;

关键词: acute kidney injury;    definition;    classification;    renal replacement therapy;    haemodialysis;    continuous dialysis;   

DOI  :  10.1515/sjecr-2017-0050

来源: DOAJ

【 摘 要 】

Acute damage to the kidney is a serious complication in patients in intensive care units. The causes of acute kidney damage in these patients may be prerenal, renal and postrenal. Sepsis is the most common cause of the development of acute kidney damage in intensive care units. For the definition and classification of acute kidney damage in clinical practice, the RIFLE, AKIN and KDIGO classifications are used. There is a complex link between acute kidney damage and other organs. Acute kidney damage is induced by complex pathophysiological mechanisms that cause acute damage and functional disorders of the heart (acute heart failure, acute coronary syndrome and cardiac arrhythmias), brain (whole body cramps, ischaemic stroke and coma), lung (acute damage to the lung and acute respiratory distress syndrome) and liver (hypoxic hepatitis and acute hepatic insufficiency). New biomarkers, colour Doppler ultrasound diagnosis and kidney biopsy have significant roles in the diagnosis of acute kidney damage. Prevention of the development of acute kidney damage in intensive care units includes maintaining an adequate haemodynamic status in patients and avoiding nephrotoxic drugs and agents (radiocontrast agents). The complications of acute kidney damage (hyperkalaemia, metabolic acidosis, hypervolaemia and azotaemia) are treated with medications, intravenous solutions, and therapies for renal function replacement. Absolute indications for acute haemodialysis include resistant hyperkalaemia, severe metabolic acidosis, resistant hypervolaemia and complications of high azotaemia. In the absence of an absolute indication, dialysis is indicated for patients in intensive care units at stage 3 of the AKIN/KDIGO classification and in some patients with stage 2. Intermittent haemodialysis is applied for haemodynamically stable patients with severe hyperkalaemia and hypervolaemia. In patients who are haemodynamically unstable and have liver insufficiency or brain damage, continuous modalities of treatment for renal replacement are indicated.

【 授权许可】

Unknown