CVVH is becoming increasingly utilized in pediatric acute renal failure. However, in patients who have acute renal failure, the institution of CVVH is often followed by a progression to oliguria or anuria. The underlying pathophysiology of this change is unknown.
Full Answer
Does CVVH work for acute renal failure?
Study of Patients With Acute Renal Failure on CVVH. CVVH is a continuous, gentle form of removing excess fluids and small wastes from the blood, similar to kidney dialysis (artificial kidney). It is an accepted therapy for temporary support of kidney failure. In some patients with acute kidney failure, beginning CVVH is followed by...
Can CVVH clear myoglobin effectively in patients with RM and Aki?
Conclusion: Our study showed CVVH can be employed to clear myoglobin effectively in patients with RM and AKI and presented oliguria.
What is the CVVH program?
- Our CVVH program offers short-term treatment for inpatients with kidney dysfunction accompanied by low blood pressure. Therapy is performed in the ICU or OR setting as applicable. The Continuous Veno-Venous Hemofiltration (CVVH) program is a short term treatment used in ICU patients with acute or chronic renal failure.
What is continuous veno venous hemofiltration (CVVH)?
Continuous Veno-Venous Hemofiltration (CVVH) is a temporary treatment for patients with acute renal failure who are unable to tolerate hemodialysis and are unstable. With CVVH, a dialysis catheter is placed in one of the main veins of the body. This catheter has two separate lines.
What is the purpose of Cvvh?
Continuous Veno-Venous Hemofiltration (CVVH) is a temporary treatment for patients with acute renal failure who are unable to tolerate hemodialysis and are unstable. With CVVH, a dialysis catheter is placed in one of the main veins of the body.
What is the treatment of oliguria?
Oliguria is likely to need medical treatment unless your urine output is low because you haven't been taking in enough fluids. You may be able to treat yourself in that case by drinking more fluids, such as plain water or rehydration solutions that contain electrolytes.
How do you treat oliguria in AKI?
In the case of oliguric or anuric AKI, diuretics are often utilized to increase the urine output although current evidence suggests that they are best reserved for the treatment of volume overload and hyperkalemia in patients who are likely to respond to them.
Is oliguria an indication for dialysis?
Bellomo, in his chapter for Oh's Manual, lists the following "modern" indications for dialysis in the ICU: Oliguria (less than 200ml in 12 hours) Anuria (0-50ml in 12 hours) Urea over 35 mmol/L.
Why does oliguria cause nephrotic syndrome?
The classic symptoms of the nephritic syndrome are: Hypertension or poorly controlled blood pressure (BP) in patients with previously controlled BP. Renal insufficiency characterized by oliguria (reduced urine output), and azotemia, due to decreased glomerular filtration rate (GFR)
How is anuria treated?
The exact treatment for anuria depends on the underlying condition that's causing it. Kidney disease may be treated with dialysis to remove fluids and waste. Ureteral stents may also help collect urine. A kidney transplant is considered a last resort.
Does oliguria cause hyperkalemia?
Decreased potassium excretion: The most common cause of decreased potassium excretion leading to hyperkalemia is oliguric renal failure.
Why does acute kidney injury cause oliguria?
Renal causes of oliguria arise as a result of tubular damage. As a result of the tubular damage, the kidney loses its normal function i.e., production of urine while excreting the waste metabolites.
Why are fluids restricted in acute kidney injury?
BACKGROUND: Fluid is restricted in thoracic surgery to reduce acute lung injury, and hydroxyethyl starches (HES) are often administered to reduce fluid amount. This strategy may contribute to the development of acute kidney injury (AKI).
What is oliguric renal failure?
Oliguria is defined as a daily urine volume of less than 400 mL and has a worse prognosis. Anuria is defined as a urine output of less than 100 mL/day and, if abrupt in onset, suggests bilateral obstruction or catastrophic injury to both kidneys.
Does fluid overload cause oliguria?
Third, fluid overload may result from overzealous fluid administration or oliguria or a combination of the two.
What are the 6 indications for dialysis?
IndicationsAcute kidney injury.Uremic encephalopathy.Pericarditis.Life-threatening hyperkalemia.Refractory acidosis.Hypervolemia causing end-organ complications (e.g., pulmonary edema)Failure to thrive and malnutrition.Peripheral neuropathy.More items...•
Atrial Natriuretic Peptide
- During the past decade, experimental studies in animals and humans have focused on restoration of renal hemodynamics and tubule cell integrity. Atrial natriuretic peptide (ANP) has been shown to improve renal function in animal models of ischemic acute kidney injury, predominantly via afferent arteriolar dilatation. In a large study of adults, ANP ...
Considerations in Pharmacotherapy
- Nephrotoxic agents should be avoided because they may worsen the renal injury and delay recovery of function. Such agents include contrast media, aminoglycosides, and NSAIDs. Prescribing medication requires knowledge of the route of elimination and adjustments in dose or frequency based on residual renal function. Patients in the early phase with a rising creatinine sh…
Consultations
- Consult a pediatric nephrologist for management of all cases of oliguria, except in children with prerenal insufficiency from dehydration who have promptly responded to fluid therapy or those with mild nephrotoxic injury who have responded to discontinuation of the drug. Consult a pediatric urologist for the management of obstruction.
Transfer
- If the patient with oliguria requires close monitoring of hemodynamic status or if indications for acute dialysis are present, transfer the patient to a center with ICU facilities.