Management of acute renal failure in critically ill children

Management of Acute Renal Failure Martin Turman, MD, PhD

Acute Renal Failure ,[object Object],[object Object],[object Object],[object Object]

ARF: Causes and mortality ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Extrarenal causes of ARF: 67% of total ,[object Object],[object Object],Data pooled from Ped. Nephrol. 7:703, 8:334, 6:470, and 7:434

ARF: Risk factors for mortality ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Best cure is to prevent ,[object Object],[object Object]

Anticipate problems ,[object Object],[object Object],[object Object],[object Object]

Case #1 ,[object Object],[object Object],[object Object]

How do you proceed from here? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Prerenal azotemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Prerenal azotemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Postrenal Failure ,[object Object],[object Object],[object Object],[object Object],[object Object]

Intrinsic Acute Renal Failure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Evaluation of ARF - 1 ,[object Object],[object Object]

Evaluation of ARF - 2 ,[object Object],[object Object],[object Object],[object Object]

Evaluation for ARF - 3 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Urinary indices in ARF 40 U/P Cr 20 PR ATN FE-Na 1% 2% FE-Na = (U/P Na ÷ U/P Creatinine ) *100 Adopted from J. Crit. Illness 4:32 500 U-osm 350 PR ATN 40 U-Na 20 PR ATN PR ATN

Use of FE-Na ,[object Object],[object Object],[object Object]

Back to Case #1 (intussuception) ,[object Object],[object Object],[object Object]

Clinical Case #2 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Assessment of case #2 ,[object Object],[object Object],[object Object]

Use of plasma BUN: Cr ratio ,[object Object],[object Object]

Clinical Case #3 ,[object Object],[object Object],[object Object]

Physical exam and labs ,[object Object],[object Object],[object Object]

Fluid management in ARF ,[object Object],[object Object],[object Object],[object Object]

Management of ARF - Volume status ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Hypertension ,[object Object],[object Object],[object Object],[object Object]

Back to Case #3 (nephritis) ,[object Object],[object Object],[object Object],[object Object]

Hyperkalemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Hyperkalemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Hypocalcemia and hyperphosphatemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Hypocalcemia and hyperphosphatemia ,[object Object],[object Object],[object Object]

Acidosis ,[object Object],[object Object],[object Object],[object Object],[object Object]

Anemia and uremic bleeding ,[object Object],[object Object],[object Object]

Indications for renal replacement therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Modes of renal replacement therapy ,[object Object],[object Object],[object Object]

Unproven or controversial treatments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Unproven or controversial treatments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Effect of low-dose Dopamine on ARF Adopted from Alkhunaizi & Schrier, Am J Kidney Dis 28:315

Are there any new treatments? ,[object Object],[object Object]

New potential therapies ,[object Object],[object Object],[object Object],[object Object],[object Object]

New potential therapies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

"The great tragedy of Science - the slaying of a beautiful hypothesis by an ugly fact." T.H. Huxley (1825-1895) Collected Essays

Management of acute renal failure in critically ill children

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Management of acute renal failure in critically ill children