Palevsky

Acute Renal Failure - Pathogenesis, Diagnosis, and Therapy

(ASN Board Review, 2005). Part 1: How do we define acute renal failure (ARF)? What are the new RIFLE criteria? How do we diagnose ARF? How useful is the fractional excretion of urea? How does ARF impact on mortality? How do new theories of hepatorenal syndrome help us manage this condition? What is the abdominal compartment syndrome? How do we diagnose post-renal ARF? Interstitial nephritis? Acute vascular syndromes, and in particular, those due to atheroembolic disease?
Part 2: How does ATN present? You know about its 3 causes, but did you know about its 4 phases? Necrosis or apoptosis? What's the pathogenesis? How can renal inflammation associated with ATN affect distal organs like the heart? How can we prevent contrast nephropathy? Are low osmolar or iso-osmolar dyes useful? Is saline the gold standard? Is bicarbonate better? Can we reconcile all of the studies of N-acetylcysteine? What about fenoldopam? Theophylline? Preventive hemofiltration? Does low-dose dopamine have a role in ARF? Atrial natriuretic peptide? Are KIM-1 and NGAL of clinical use as novel markers of renal injury? Does early initiation of dialysis or CRRT help in ARF? What are the latest studies comparing intermittent HD with CRRT? What about PD and SLED? Membrane biocompatibility? More frequent (daily) intermittent dialysis? (more...)


key This quiz by Dr. Michael Kraus and Dr. Ed Sha deals with ANTICOAGULATION IN CRRT . It discusses the various anticoagulation methods available, their relative utility, and indications.
Note: Feedback section works with Internet Explorer only.

key Try Dr. Kraus's MODALITY CHOICE IN THE ICU poll. This poll queries the physician and RN audience with regard to how often CRRT is used in their ICUs, what type of CRRT is chosen, how much replacement fluid is ordered, and what sort of anticoagulation is used.
Note: Feedback section works with Internet Explorer only.
Updated: July 03, 2008 (J03)
J03 NEJM: Scanning the blood for circulating tumor cells using DNA technology helps guide treatment of metastatic disease.
J03 VA/NIH study of dialysis dose in acute kidney failure published in NEJM
J03 Novel antibiotic ceftobirole kills even the most resistant Staph. aureus.
J01 Indocyanine green plus laser light kills even resistant bacteria; application to wound infections.
J26 Two siRNA in the Phase I/II pipeline for kidney disease, one for delayed graft function, the other for AKI
J26 Cethromycin for community-acquited MRSA.
J25 MRSA skin infections becoming commonplace in healthy athletes.
J25 Radiofrequency equipment ID tags can halt dialysis machines, change ventilator settings, alter syringe pump performance in the ICU.
J19 Some pathogenic bacteria use nanosyringe to inject host cells with toxins.
J18 Computer generated warfarin dosing as effective as dosing by expert prescribers.
J18 HHV-8 herpes virus linked to ketosis-prone type 2 diabetes in Africa.
J16 Do patients with combined liver/kidney transplants really need the kidney portion?
J13 FDA and EMEA to consider biomarkers of renal injury in animal studies evaluating renal safety of new drugs.
J06 Nephros completes trial of clip-on hemodiafiltration module and high-efficiency b2-M hemodiafilter.
J05 NEJM: Heparin contaminated with oversulfated chondroitin sulfate causes anaphylaxis via kallikrein activation.
Industry Advances Emphasis
archive
Pediatric CRRT Conference Talks, 2006 (Neuhaus, Brophy, Gardner, Maxvold, Bunchman, Fishbach, Dodge-Khatami, Maggiori, Frey, Fischer, Ring, Ringe, Bonzel) PCRRT 2006 (PPT files)
Hemodiafiltration (HDF) – A Critical Evaluation of its Value (Ronco) RRI 2006 - Part 2 (handouts)
Novel Technologies for Acute Renal Failure Therapeutic Discovery (Mehta, Molitoris, Portilla) ASN Renal Week 2005 (audiofiles)
Key Issues in Managing Acute Renal Failure (Molitoris, Palevsky, Schrier) ASN Renal Week 2005 (audiofiles)
ICU Nephrology and Acute Renal Failure: What the Nephrologist Must Know (Part 1 and 2) (Fuchs, Dellinger, Palevsky, Parillo, Hollenberg, Kasner, Bekes) ASN Renal Week 2005 (audiofiles)
ICU Nephrology and Acute Renal Failure: What the Nephrologist Must Know (Part 3 and 4) (Kellum, Molitoris, Okusa, Gines, Palevsky, Marshall, Tolwani, Goldstein, Mueller, Goldfarb) ASN Renal Week 2005 (audiofiles)
Hemodiafiltration (HDF): Theory, Quantification, Clinical Management (Canaud, Clark, Kjellstrand, Traeger, Akiba) ADC 2005 (audiofiles)
Acute Renal Failure (Safirstein Chugh, Depner, Ash, Ronco, Davenport, Friedman) ADC 2005 (audiofiles)
Renal replacement therapy for ARF in liver disease: Why, what, when and where (Gonwa) ASN 2002 Renal Week
Diagnosis, pathophysiology, and management of hepatorenal syndrome (Kupin) ASN 2002 Board Review Course
Dialysate selection in the dialysis unit (Gennari) RRI 2002 Int. Dialysis Conference
Herbs and the kidney: What to beware of (Debroe)

Contaminated heparin associated with adverse clinical events and activation of the contact system N Engl J Med (Jun 2008)
Hands-only (compression-only) cardiopulmonary resuscitation: a call to action for bystander response to adults who experience out-of- hospital sudden cardiac arrest: An AHA Science Advisory Circulation (Apr 2008)
Atherosclerotic renal artery stenosis: overtreated but underrated? J Am Soc Nephrol (Apr 2008)
The Janus faces of allopurinol -- allopurinol hypersensitivity syndrome Am J Med (Mar 2008)
Technology insight: biomarker development in acute kidney injury-what can we anticipate? Nature Clin Pract Nephrol (Mar 2008)
Cerebral salt wasting versus SIADH: What difference? J Am Soc Nephrol (Feb 2008)
Beta-blockade in chronic dialysis patients Semin Dial (Feb 2008)
Atheroembolic renal disease: A silent masquerader Kidney Int (Jan 2008)
Gadolinium use in patients with kidney disease: A cause for concern Semin Dial 05-07
CRRT Meeting 2007 abstracts Blood Purif (03-2007)
A case of nephrogenic fibrosing dermopathy/nephrogenic systemic fibrosis NCPN (02-2007)
Serum anion gap: its uses and limitations in clinical medicine CJASN 01-07
Fluid balance, dry weight, and blood pressure in dialysis Hemodial Int 01-07
Electrolyte disturbances in the intensive care unit (Sedlacek , Schoolwerth, Remillard) Sem Dial 12-06
CRRT / ARF LINKS
ADQI
Eur Soc Int Care Med
CCM Society Links
San Diego Mtg - 2007
HDCN Topic Pages (KEY)
CRRT
Dialysis in ARF
Plasmapheresis
ARF etiology
ARF prevention
ARF treatment
ARF crystal-induced
ARF hypovolemic/septic
ARF drug-induced
ARF contrast
PEDIATRIC LINKS
PCRRT website

Dr. Michael Kraus, M.D.
Associate Professor of Medicine, Indiana University of School of Medicine, Indianapolis, IN