The high incidence of cisplatin-induced nephrotoxicity in elderly patients may be associated with renal hypoperfusion; increased comorbidities, such as chronic kidney disease (CKD), cardiovascular disease, and diabetes mellitus; increased use of combined drugs [especially non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitor and angiotensin receptor blockers (ACEI/ARB), and antibiotics]; decreased clearance of cisplatin; and high plasma ultrafilterable cisplatin.
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Is hypotension associated with acute kidney injury in ICU patients?
Abstract In the context of critical illness, hypotension may be associated with acute kidney injury (AKI). Using the MIMIC II database, we studied the risk of AKI in ICU patients as a function of both the severity and duration of hypotension. Multivariate logistical regression was performed to find correlations between hypotension and AKI.
Which medications are used to treat acute kidney injury (AKI)?
Metformin is used to treat diabetes in patients with acute kidney injury (AKI). c. Iodinated dyes are used for imaging techniques in patients with acute kidney injury (AKI). d. IV isotonic saline infusion is the primary treatment intervention in hypovolemic patients with acute kidney injury (AKI). d.
What medications increase the risk of acute renal failure?
Diuretics, ACEIs, ARBs, and NSAIDs: A Nephrotoxic Combination. This triple therapy can increase the risk of acute renal failure AKI include surgery, especially for older patients or patients of any age with elevated creatinine levels.
How does Renal hypoperfusion affect glomerular capillary pressure?
Renal artery stenosis, malignant hypertension Open in a separate window Renal hypoperfusion reduces glomerular capillary pressure and the GFR.
What medication is used to protect kidneys?
Angiotensin-converting enzyme inhibitors (ACE inhibitors) or Angiotensin II Receptor Blockers (ARBs) are medicines that help protect the kidneys.
What treatment is used for acute kidney injury?
Most people with AKI make a full recovery, but some people go on to develop chronic kidney disease or long-term kidney failure as a result. In severe cases, dialysis, where a machine filters the blood to rid the body of harmful waste, extra salt and water, may be needed.
What is hypoperfusion of the kidneys?
Renal hypoperfusion occurs when renal autoregulation is impaired owing to a fall in the mean arterial pressure to below 80 mm Hg [5].
Which medications are safe to continue in patients with AKI?
If a patient experiences an initial episode of AKI, this defines them as someone who is close to this 'cliff edge'. On recovery, in the absence of intercurrent illness, use of ACEI/ARB, diuretics or both may again be safe and the benefits of these drugs can be realised.
What pharmacological agents manage acute renal failure?
Lasix (furosemide) is the most commonly prescribed diuretic, but it needs to be managed to prevent drug resistance. In addition, the combined use of ACE inhibitors (commonly used to treat high blood pressure) and statin drugs (used to reduce cholesterol) may help normalize kidney function.
What antibiotics treat AKI?
AKI was defined by the Acute Kidney Injury Network (AKIN) criteria based on both urine output and serum creatinine (SCr). The three antibiotic combinations assessed for outcomes were piperacillin-tazobactam/vancomycin (PTZ/VAN), cefepime/vancomycin (CEF/VAN), and meropenem/vancomycin (MER/VAN).
What causes hypoperfusion?
Hypoperfusion is a term that describes "a reduced amount of blood flow". When ischemia develops due to low blood flow, we may describe this as "hypoperfusion". Causes for hypoperfusion include low blood pressure, heart failure or loss of blood volume. Ischemia can affect any organ of the body.
How do you improve renal perfusion?
When hemodynamics are maximized, renal perfusion can only be improved by shunting a higher proportion of cardiac output to the kidney; however, in low-flow states, this reduces already compromised systemic pressure and perfusion to other organs.
How is Prerenal kidney injury treated?
In the emergency department or the hospital setting, the mainstay of treatment of prerenal AKI is isotonic fluid administration. It is both therapeutic and diagnostic. A downtrend in creatinine after administration of isotonic fluids is the gold standard in diagnosis.
Why are ACE inhibitors stopped in AKI?
Clinicians managing patients with AKI therefore frequently stop drugs that lower blood pressure (particularly ACEI and ARBs, which selectively reduce glomerular pressure) and diuretics. ACEIs, ARBs and potassium-sparing diuretics may also be stopped because of hyperkalaemia.
What do beta-blockers do to kidneys?
Theoretically, beta-blockers may reduce cardiac output and subsequently renal perfusion pressure, thereby exacerbating renal dysfunction. The sympathetic nervous system (SNS) is activated in CKD, which is a known factor in the progression of renal disease [6].
Which drug is contraindicated in acute renal failure?
Problematic drugs whose use in patients with renal insufficiency is nephrologically contraindicated: Pethidine, cefepime, lithium, gilbenclamide, gimepiride, metformin, spironolactone, eplerenone, methotrexate, gadolinium, enoxaparin.
How to prevent kidney failure?
According to the Mayo Clinic, having a healthy lifestyle that includes regular physical activity and a sensible diet can help to prevent kidney failure. Work with your doctor to manage existing medical conditions that could lead to acute kidney failure.
What causes a decrease in blood flow to the kidneys?
The following conditions can lead to decreased blood flow to your kidneys: Certain disorders can cause clotting within your kidney’s blood vessels, and this can lead to acute kidney failure. These conditions include: Some infections, such as septicemia and acute pyelonephritis, can directly injure your kidneys.
What happens when your kidneys lose their filtering ability?
Acute kidney failure happens when your kidneys suddenly lose the ability to eliminate excess salts, fluids, and waste materials from the blood. This elimination is the core of your kidneys’ main function. Body fluids can rise to dangerous levels when kidneys lose their filtering ability. The condition will also cause electrolytes ...
What is the best test for acute kidney failure?
An ultrasound is the preferred method for diagnosing acute kidney failure. However, abdominal X-ray, abdominal CT scan, and abdominal MRI can help your doctor determine if there’s a blockage in your urinary tract. Certain blood tests may also reveal underlying causes of acute kidney failure.
How long does it take for acute kidney failure to develop?
It’s common in people who are already in the hospital. It may develop rapidly over a few hours. It can also develop over a few days to weeks. People who are critically ill and need intensive care have the highest risk of developing acute kidney failure.
Why does blood flow decrease in the kidneys?
The following conditions can lead to decreased blood flow to your kidneys: Certain disorders can cause clotting within your kidney’s blood vessels, and this can lead to acute kidney failure. These conditions include:
How to reduce kidney toxins?
Diet. Your doctor will restrict your diet and the amount of liquids you eat and drink. This will reduce the buildup of toxins that the kidneys would normally eliminate. A diet high in carbohydrates and low in protein, salt, and potassium is usually recommended.
What is the effect of ACE inhibitors on the kidney?
A risk-benefit assessment. ACE inhibitors effectively reduce systemic vascular resistance in patients with hypertension, heart failure or chronic renal disease. This antihypertensive efficacy probably accounts for an important part of their long term renoprotective effects in patients with diabetic ...
Does sodium depletion affect renal function?
Consequently, sodium repletion contributes to the restoration of renal function in patients with ACE inhibitor-induced acute renal failure. Our the other hand, co-treatment with diuretics and sodium restriction can improve ...
Can ACE inhibition cause renal failure?
In conditions in which glomerular filtration is critically dependent on angiotensin II-mediated efferent vascular tone (such as a post-stenotic kidney, or patients with heart failure and severe depletion of circulating volume), ACE inhibition can induce acute renal failure , which is reversible after withdrawal of the drug.
Does filtration pressure affect renoprotection?
The fall in filtration pressure presumably contributes to the antiproteinuric effect as well as to long term renoprotection. The former is suggested by the positive correlation between the fall in filtration fraction and the reduction in proteinuria found during ACE inhibition.
Does ACE help with hypertension?
ACE inhibitors effectively reduce systemic vascular resistance in patients with hypertension, heart failure or chronic renal disease. This antihypertensive efficacy probably accounts for an important part of their long term renoprotective effects in patients with diabetic and non-diabetic renal disease. The renal mechanisms underlying the renal ...
What is the most common cause of acute renal failure?
Prerenal azotemia is the most common cause of acute renal failure. It is an excess of nitrogen compounds in your blood stream due to a lack of blood flow to each kidney. Prerenal azotemia is caused by decreased blood flow to the kidneys, usually associated with poor systemic perfusion.
What are the risk factors for renal cell carcinoma?
Obesity; exposure to asbestos, cadmium, and/or gasoline; the use of phenacetin- and aspirin-containing analgesics; and chronic hemodialysis for acquired polycystic kidney disease are all risk factors for renal cell carcinoma. Cigarette smoking has a 25% to 30% correlation with the development of renal cell carcinoma.
What are the etiologies of vascular disease?
Etiologies includes hypovolemia, altered peripheral vascular resistance, diminished cardiac output, congestive heart failure, renal artery disorders such as vasculitis, and to a lesser extent thromboembolic disease, as well as chronic liver diseases such as cirrhosis and the hepatorenal syndrome.
What is the treatment for renal neoplasm?
Treatment for a renal neoplasm is primarily surgical with a partial or total nephrectomy, with or without regional lymphadenectomy if no metastatic disease is present. At the time of the neoplasm diagnosis, the patient should be referred to a urologist for a surgical evaluation and to an oncologist for cancer treatment.
Is hospitalization necessary for pregnant women?
Likewise, the patient's degree of systemic illness (bacteremia or urosepsis), age, history of chronic disease, or nonadherence to therapy may lead to the assessment that hospitalization is necessary.
Is AKI a risk for open heart surgery?
Community-based AKI occurs more frequently among vulnerable populations such as individuals with underlying renal disease, multiple myeloma, or diabetes. AKI is also one of the potential risks related to open-heart surgery and other cardiac procedures (e.g., cardiac catheterization) and use of IV contrast dyes.