Sepsis acute renal failure

Renal Effects. Hemorrhage of the medullary layer of the kidneys was observed in an early report of three fatal cases of acute oral poisoning with endosulfan (Terziev et al. 1974). More recent studies have reported acute renal failure after ingestion of endosulfan as a major contributing cause of death in two individuals in both cases, postmortem examination showed extensive tubular necrosis (Blanco-Coronado et al. 1992 Lo et al. 1995). Neither case discussed the possible mechanism of endosulfan-induced acute renal failure, but in one case, the authors of the report indicate that the renal lesions may relate to sepsis and shock (Blanco-Coronado et al. 1992). Ingested doses were not determined in any of these cases, and it is not totally clear that the effects observed at autopsy were a direct result of endosulfan exposure, although based on results from acute animal studies, it seems likely. 

Patients with nephrotic syndrome can develop acute renal failure as a consequence of intravascular hypovolemia and/or sepsis with subsequent prerenal azotemia or acute tubular necrosis. Renal hypoperfusion in these patients can be potentiated by the administration of diuretics, inhibitors of angiotensin-converting... 

Florl WEI, Schafer RM, Florl M, Fleidland A Neutrophil activation in acute renal failure and sepsis. Arch.Surg. 125 651-654,1990... 

Flolly MK, Dear JW, Flu X, Schechter AN, Gladwin MT, Flewitt SM, Yuen PS, Star RA Biomarker and drug-target discovery using proteomics in a new rat model of sepsis-induced acute renal failure. Kidney International 70 496-506, 2006... 

Dear JW, Yasuda H, Hu X, Hieny S, Yuen PS, Hewitt SM, Sher A, Star RA Sepsis-induced organ failure is mediated by different pathways in the kidney and liver acute renal failure is dependent on MyD88 but not renal cell apoptosis. Kidney International 69 832-836,2006... 

Acute renal failure 4pg,4rbe,4gpr Hemodynamic disruption CHF, renal disease, hepatic disease, diuretic use, advanced age, dehydration, SEE, shock, sepsis, hyperreninemia, hyperaldosteronemia Discontinue NSAID, support with dialysis and steroids, if needed... 

Power D A, Duggan J, Brady H R 1999 Renal-dose (low-dose) dopamine for the treatment of sepsis-related and other forms of acute renal failure ineffective and probably dangerous. Clinical and Experimental Pharmacology and Physiology 26(suppl) S23-S28 Rose B D 1989 In Rose B D (ed) Clinical physiology of acid-base and electrolyte disorders, 3rd edn. McGraw Hill, New York, pp. 389-415... 

Patients at risk for SRMB include those with respiratory failure (need for mechanical ventilation for >48 hours), coagulopathy, hypotension, sepsis, hepatic failure, acute renal failure, multiple trauma, severe burns (>35% of body surface area), head injury, traumatic spinal cord injury, major surgery, or history of GI bleeding. " ""... 

Neveu H, Kleinknecht D, Brivet F, et al. Prognostic factors in acute renal failure due to sepsis. Results of a prospective multicentre study. Nephrol Dial Transplant 1996 11 293-299. 

Acute renal failure occurs in approximately 5% of all hospitalized patients. The mortality rate of ARF patients who require renal replacement therapy ranges from 40% to as high as 80%. Severe malnutrition has been found in 42% of patients with ARF and is an independent predictor of in-hospital mortality and increased morbidity from sepsis, shock, dysrhythmias, and acute respiratory failure. Since malnutrition is an important contributor to mortality from ARF, nutrition support remains a cornerstone in the treatment of these patients. ... 

The finding that hemoperfusion through the polymeric BetaSorb column effectively removes several middle-molecular-weight toxic proteins and that such toxins and cytokines are heavily involved in the systemic inflammatory response syndrome (SIRS) have stimulated extensive preclinical studies to demonstrate the wider utility of the hemoperfusion procedure. Winchester et al. [365] list 24 cytokines and other protein and glycoprotein molecules in the molecular weight range of 4—llOkDa that are implicated in SIRS. In addition to ESRD, SIRS is caused by various other health problems, such as acute renal failure (350,000 cases per year in the USA), cardiopulmonary bypass surgery (1.5 million/year), and sepsis. 

Schrier RW Wang W. (2004). Acute renal failure and sepsis. New Engl J Med 351, 159-169. 

Indications for renal replacement therapy in the acute setting and for other disease processes are different from those for ESRD. A common mode of ESRD therapy in the outpatient setting is intermittent hemodialysis (IHD) where a patient receives intense treatment over the course of a few hours several times a week. Acute renal failure in the inpatient setting is often treated with continuous renal replacement therapy (CRRT), which is applied for the entire duration of the patient s clinical need and relies upon hemofiltration to a higher degree than IHD (Meyer, 2000). Other nonrenal indications for CRRT are based on the theoretical removal of inflammatory mediators or toxins and elimination of excess fluid (Schetz, 1999). These illnesses include sepsis and systemic inflammatory response syndrome, acute respiratory distress syndrome, congestive heart failure with volume overload, tumor lysis syndrome, crush injury, and genetic metabolic disturbances (Schetz, 1999). 

At less than 2% in the clinical investigations acute renal failure, atrial fibrillation, cerebrovascular accident, sepsis, meningitis, psychotic disorder, suicidal ideation, respiratory distress, rhabdomyolysis, electrocardiogram abnormal, stupor, loss of consciousness, incoherent, clonic convulsion and grand mal convulsion. Rare instances of fatal pneumonia aspiration and suicide attempt were reported (<1%). 

A 73-year-old man with acute respiratory failure, presumed to be secondary to amiodarone toxicity, developed sepsis and acute renal insufficiency, and required intermittent hemodialysis. Following a Herpes simplex labialis infection he was treated with oral aciclovir (400 mg tds). The next day he became sleepy, disoriented, and agitated. Over the next 48 hours his neurological condition deteriorated and he responded to pain... 

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