Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/11023
Title: Fluid management in septic acute kidney injury and cardiorenal syndromes.
Authors: Bellomo, Rinaldo;Prowle, John R;Echeverri, Jorge E;Ligabo, Valentina;Ronco, Claudio
Affiliation: Department of Intensive Care, Austin Health, Heidelberg, Melbourne, Vic., Australia. rinaldo.bellomo@austin.org.au
Issue Date: 20-Apr-2010
Citation: Contributions To Nephrology 2010; 165(): 206-18
Abstract: Intravenous fluids are commonly administered to patients with developing septic acute kidney injury (AKI). Conversely, fluids are just as commonly removed with diuretics or renal replacement therapy (RRT) techniques or ultrafiltration in patients with cardiorenal syndromes (CRS). In both groups, there is controversy regarding fluid management. However, in patients with septic AKI, the deleterious consequences of overzealous fluid therapy are increasingly being recognized, while concerns exist both about the possible adverse effects of excessive and/or insufficient fluid removal with diuretics or ultrafiltration in CRS. In this article, we discuss how interstitial edema can further delay renal recovery and why conservative fluid strategies are now being advocated in septic AKI. In patients with septic AKI, this strategy might require RRT to be given earlier to assist with fluid removal. However, in patients with either septic AKI or CRS, hypovolemia and renal hypoperfusion can occur if excessive fluid removal is pursued with diuretics or extracorporeal therapy. Thus, accurate assessment of fluid status and careful definition of targets are needed to improve clinical outcomes. Controlled studies of conservative versus liberal fluid management in patients with AKI or CRS seem justified.
Internal ID Number: 20427971
URI: http://ahro.austin.org.au/austinjspui/handle/1/11023
DOI: 10.1159/000313760
URL: http://www.ncbi.nlm.nih.gov/pubmed/20427971
Type: Journal Article
Subjects: Acute Kidney Injury.complications.etiology.physiopathology.therapy
Blood Pressure
Cardiac Output, Low.complications.physiopathology
Central Venous Pressure.physiology
Critical Illness
Diuretics.adverse effects.therapeutic use
Edema.etiology.physiopathology
Extracellular Fluid.physiology
Fluid Therapy.adverse effects
Glomerular Filtration Rate
Heart Diseases.complications.physiopathology.therapy
Humans
Kidney Glomerulus.physiopathology
Kidney Tubules.physiopathology
Renal Replacement Therapy.methods
Shock, Septic.complications.therapy
Syndrome
Appears in Collections:Journal articles

Files in This Item:
There are no files associated with this item.


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.