Thursday, March 28, 2013

Acute kidney injury (AKI)

Lots of good stuff in this review.

Some take home points:

The cornerstone of assessment and management is volume.

Assess volume and volume responsiveness (which can be a little tricky, and how you do that depends on the resources where you practice) and replete as indicated.

Low FeNa does not always mean volume responsive. Exceptions are listed and discussed.

Though aggressive volume resuscitation is indicated in early septic shock and often early AKI a price is often paid later in terms of organ congestion (lungs, kidneys, skin, abdominal compartment) such that less may be more in the later stages.

Diuretics have not been proven to lead to improvement in hard clinical outcomes although there may be some benefit in mitigating volume overload and hyperkalemia in those patients capable of responding.

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