التفاصيل البيبلوغرافية
| العنوان: |
Acute Kidney Injury: A Frequently Underestimated Problem in Perioperative Medicine. |
| المؤلفون: |
Weiss, Raphael, Meersch, Melanie, Pavenstädt, Hermann-Joseph, Zarbock, Alexander |
| المصدر: |
Deutsches Ärzteblatt International; 12/6/2019, Vol. 116 Issue 49, p833-842, 13p, 1 Chart |
| مستخلص: |
Background: Surgical patients are getting older with increasing comorbidity. Acute kidney injury (AKI) is a commonly underestimated perioperative complication. 2-18% of hospitalized patients and 22-57% of patients in the intensive care unit develop AKI. Even though it has a major impact on patients' outcomes, it goes unrecognized in 57-75.6% of cases. Methods: This review is based on pertinent papers retrieved by a selective search in PubMed and the Cochrane Library employing the searching terms "acute kidney injury," "biomarker," "perioperative," "renal function," and "KDIGO." Results: The pathophysiology of AKI is complex. Conventional biomarkers are either not specific enough (urine output) or not sensitive enough (serum creatinine) for timely diagnosis. In view of the pathophysiology of the condition and the limited treatment options for it, the early detection of subclinical AKI (kidney damage without functional impairment) would seem to be a reasonable first step toward the prevention of worsening or permanent renal injury. New biomarkers of damage enable the early initiation of nephroprotective interventions. According to the "Kidney Disease: Improving Global Outcomes" (KDIGO) statement, a multimodal treatment approach is needed, including, among other things, optimization of hemodynamics and the discontinuation of nephrotoxic drugs. Conclusion: It is essential to identify patients at risk and sensitize the treating personnel to the implementation of the guidelines. The incorporation of new biomarkers into routine clinical practice is also reasonable and necessary. Future clinical trials must show in what form these biomarkers should be used (singly or collectively). [ABSTRACT FROM AUTHOR] |
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