Renal protection and nephritic support
Cardiopulmonary Bypass: Advances in Extracorporeal Life Support, Elsevier, ss.723-742, 2022
- Yayın Türü: Kitapta Bölüm / Araştırma Kitabı
- Basım Tarihi: 2022
- Doi Numarası: 10.1016/b978-0-443-18918-0.00046-2
- Yayınevi: Elsevier
- Sayfa Sayıları: ss.723-742
- Anahtar Kelimeler: Acute kidney injury, anuria, cardiac surgery, cardiopulmonary bypass, glomerular filtration rate, hemodialysis, hemofiltration, kidney replacement therapy, nephrotoxic, oliguria, renal perfusion
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Acute kidney injury (AKI) is one of the most important complications of cardiopulmonary bypass (CPB), which causes stress on the kidneys to enhance its glomerular filtration, leading to increased serum creatinine clearance values that return to baseline within 48hours. Simply, AKI is defined as a sudden deterioration of kidney functions, that is, serum creatinine elevation and/or urine output reduction, due to a significant decrease in glomerular filtration rate in the peri- and/or postoperative period. The first stage of kidney failure is kidney injury. Underlying mechanisms in the pathophysiology of AKI include extracorporeal circulation-related renal perfusion perturbations, activation of proinflammatory mediators, and direct nephrotoxicity. Moreover, it is also an independent risk factor of mortality in patients undergoing cardiac surgery. There is currently no specific treatment approach for CPB-related AKI. The first step in the treatment is to identify patients at risk of developing AKI preoperatively. Timely detection and diagnosis of kidney injury along with renal preventive and protective measures contribute an essential role in patients’ outcome. Kidney replacement therapy (KRT) should be considered the main treatment modality in patients with progressive renal function deterioration, uremic findings, and oligoanuria despite precautions. However, the timing, modality, and phase to terminate KRT in patients are still controversial.