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Renal Complications

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Non-Pulmonary Complications of Critical Care

Part of the book series: Respiratory Medicine ((RM))

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Abstract

Acute kidney injury (AKI) is a common problem in critically ill patients and is associated with adverse clinical outcomes, including increased mortality. Elevation in serum creatinine is the primary diagnostic indicator of AKI. Critically ill patients pose a diagnostic and therapeutic challenge as their clinical circumstances are frequently changing, and alterations in serum creatinine and glomerular filtration rate often lag behind the onset of renal injury. Analysis of urine sediment, osmolality, electrolytes, and renal ultrasound can aid in the diagnosis of AKI and distinguish between prerenal, postrenal and intrinsic causes of renal failure. Some of the most common causes of AKI encountered by intensivists will be discussed here, including ischemic injury, medication-related nephrotoxicity, rhabdomyolysis, acute tubulointerstitial nephritis, and vascular processes. Treatment of AKI depends on the etiology and often includes removal of an injurious medication or exposure. In addition, fluid administration is a major component of therapy in most cases. Renal replacement therapy is available for more severe cases of AKI with critical electrolyte abnormalities, severe acidemia, or massive volume overload refractory to non-invasive medical treatment.

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Author information

Authors and Affiliations

  1. University of Pittsburgh Medical Center, Montefiore Hospital, 3459 Fifth Avenue, NW 628, Pittsburgh, PA, 15213, USA

    Elizabeth J. Lechner M.D.

  2. Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Montefiore Hospital, 3459 Fifth Avenue, NW 628, Pittsburgh, PA, 15213, USA

    Michael G. Risbano M.D., M.A., F.C.C.P.

Authors
  1. Elizabeth J. Lechner M.D.
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  2. Michael G. Risbano M.D., M.A., F.C.C.P.
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Correspondence to Michael G. Risbano M.D., M.A., F.C.C.P. .

Editor information

Editors and Affiliations

  1. Pulmonary, Critical Care, and Sleep, Harvard Medical School Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    Jeremy B. Richards

  2. Pulmonary and Critical Care, University of Vermont College of Medicine, Burlington, Vermont, USA

    Renee D. Stapleton

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Lechner, E.J., Risbano, M.G. (2014). Renal Complications. In: Richards, J., Stapleton, R. (eds) Non-Pulmonary Complications of Critical Care. Respiratory Medicine. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-0873-8_2

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  • DOI: https://doi.org/10.1007/978-1-4939-0873-8_2

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  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-4939-0872-1

  • Online ISBN: 978-1-4939-0873-8

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