AKI Master.ppt acute kidney injury in icu

Acute kidney injury

1. AKI in ICU Dr . Mahmoud said

2. Agenda The Concept of Acute Kidney Injury and the RIFLE Criteria Critical Care Nephrology: A Multidisciplinary Approach Causes of AKI in ICU Septic AKI is not only pre renal .Role of inflammation Emerging Biomarkers of Acute Kidney Injury Sepsis and Multiple Organ Failure Fluid Resuscitation and the Septic Kidney: The Evidence Nutritional Support during Renal Replacement Therapy Vascular Access for HD and CRRT Dialysis modalities in ICU

3. Acute renal failure or, to use the more recent term, acute kidney injury (AKI) is a common syndrome in hospitals and intensive care units. the hospital mortality of severe injury (RIFLE category F) approximates 50% AKI in the ICU is an independent risk factor for death.?? What makes AKI is so deadly is not the loss of renal clearance but rather AKI’s association with multiorgan dysfunction.

4. Epidemiology of Acute Kidney Injury in the Intensive Care Unit Acute kidney injury (AKI) is common and associated with substantial morbidity, mortality, and medical costs. AKI is currently defined by KDIGO (Kidney Disease: Improving Global Outcomes) criteria and is divided into 3 stages based on increases in serum creatinine level or decreases in urine output. A recent multinational study with more than 1,800 patients from 97 intensive care units (ICUs) reported that AKI of any stage developed within 1 week of admission in 57% of patients. Severe (stage 2 or 3) AKI occurred in 39%, and 13.5% required renal replacement therapy (RRT).

5. Mortality rates of AKI requiring RRT (AKI-RRT) range from 40% to 55%, higher than mortality rates reported for myocardial infarction in the ICU (20%), sepsis without AKI (15%-25%), and acute respiratory distress syndrome (ARDS) requiring mechanical ventilation (30%-40%). In addition to mortality, AKI survivors are more likely to develop significant morbidity such as chronic kidney disease (including kidney failure) it appears that it is not the loss of renal clearance but rather AKI’s association with multiorgan dysfunction that makes AKI so deadly.

6. AKI Risk Stratification in the ICU [TIMP-2] × [IGFBP-7] (the product of tissue inhibitor of metalloproteinase 2 and insulin like growth factor binding protein 7) and NGAL (neutrophil gelatinase-associated lipocalin ).

7. Biomarkers of AKI

8. AKI Risk Stratification in the ICU

9. Implication of RIFLE AKI, as defined by the RIFLE criteria, is now recognized as a important ICU syndrome along side other syndromes used in ICU patients for the purpose of epidemiology and trial execution such as the ALI/ARDS consensus criteria [17] and the consensus definitions for SIRS/sepsis/severe sepsis and septic shock [18]. The introduction of the RIFLE system into the clinical arena represents a useful step in the field of critical care nephrology.

10. Causes of AKI in ICU 1-Sepsis 2-Cardiac surgery 3-Acute liver failure 4-Intraabdominal HTN 5-Hepatorenal syndrome 6-Malignancy 7-Cardiorenal syndrome

11. The degree of organ dysfunction in patients with MOF can be assessed using various organ dysfunction scoring systems, one of the most widely used being the sequential organ failure assessment (SOFA) score. The SOFA score considers the function of 6 organ systems – cardiovascular, respiratory , neurological, hepatic, renal, and coagulation

12. SOFA Score

13. The Role of the General Intensivist in Critical Care Nephrology Critically ill patients with renal failure often have multiple ongoing acute processes and require a multidisciplinary approach to management. This is ideally performed in a multidisciplinary ICU with patients cared for by trained intensivists available 24 h/day, 7 days/week. The general intensivist is, therefore, a key element to providing effective ICU care for all critically ill patients, including those with renal failure, and other systems of care should be avoided. The nephrologist, therefore, should not be responsible for ICU patients with acute renal failure (any more than the pneumologist should care for patients with acute respiratory failure or the cardiologist for patients with cardiac failure), unless they have received specialist training in intensive care medicine. Closed ICU Scientific Discussions, Research, and Training Importantly, specialists should be invited to seminars and other scientific discussions within the intensive care department whenever the topic includes aspects relevant to their specific field