domingo, 14 de junio de 2015

Más de protección renal/More on kidney protection

Estrategias preventivas de falla renal aguda en cirugía cardiaca. Revisión integradora
Strategies for prevention of acute kidney injury in cardiac surgery: an integrative review.
Santana-Santos E, Marcusso ME, Rodrigues AO, Queiroz FG, Oliveira LB, Rodrigues AR, Palomo Jda S.
Rev Bras Ter Intensiva. 2014 Apr-Jun;26(2):183-92.
Acute kidney injury is a common complication after cardiac surgery and is associated with increased morbidity and mortality and increased length of stay in the intensive care unit. Considering the high prevalence of acute kidney injury and its association with worsened prognosis, the development of strategies for renal protection in hospitals is essential to reduce the associated high morbidity and mortality, especially for patients at high risk of developing acute kidney injury, such as patients who undergo cardiac surgery. This integrative review sought to assess the evidence available in the literature regarding the most effective interventions for the prevention of acute kidney injury in patients undergoing cardiac surgery. To select the articles, we used the CINAHL and MedLine databases. The sample of this review consisted of 16 articles. After analyzing the articles included in the review, the results of the studies showed that only hydration with saline has noteworthy results in the prevention of acute kidney injury. The otherstrategies are controversial and require further research to prove their effectiveness.
Obesidad y protección renal
Obesity and kidney protection.
Chandra A, Biersmith M, Tolouian R.
J Nephropathol. 2014 Jul;3(3):91-7. doi: 10.12860/jnp.2014.18. Epub 2014 Jul 1.
CONTEXT: Obesity, both directly and indirectly, increases the risk for a variety of disease conditions including diabetes, hypertension, liver disease, and certain cancers, which in turn, decreases the overall lifespan in both men and women. Though the cardiovascular risks of obesity are widely acknowledged, less often identified is the relationship between obesity and renal function. EVIDENCE ACQUISITIONS: Directory of Open Access Journals (DOAJ), Google Scholar, PubMed, EBSCO and Web of Science has been searched. RESULTS:
The concept of the "Metabolic Syndrome" helps us to understand this close link between obesity, diabetes, hypertension, and renaldysfunction. An elevated body mass index has shown to be one of the major determinants of glomerular hyperfiltration that lead to the development of chronic kidney disease. Interestingly, weight loss can lead to attenuation of hyperfiltration in severely obese patients suggesting a possible therapeutic option to combat obesity-related hyperfiltration.
CONCLUSIONS: Various treatment strategies had been suggested to decrease impact of obesity on kidneys. These are blood pressure controling, inhibition of the renin-angiotensinaldosterone axis, improving glycemic control, improving dyslipidemia, improving protein uriaand lifestyle modifications. Regardless of the numerous pharmacotherapies, the focus should be on the root cause: obesity.
KEYWORDS: Fat; Metabolic syndrome; Renal disease
Protección renal perioperativa. Revisión de las estrategias
Peri-operative renal protection: The strategies revisited.
Bajwa SJ, Sharma V.
Indian J Urol. 2012 Jul;28(3):248-55. doi: 10.4103/0970-1591.102691.Abstract
Postoperative acute renal failure (ARF) is a serious complication which can result in a prolonged hospital stay and a high mortality and morbidity. Underlying renal disease, cardiac diseases, nephrotoxin exposure and renal hypoperfusion are the possible predisposing risk factors which can create a high probability for the development of ARF. The incidence of ARF is highest after major vascular, cardiac and high-risk thoraco-abdominal surgery. Among the various renal protection strategies, adequate peri-operative volume expansion and avoidance of hypovolemia is the most accepted and practiced strategy. Numerous bio-markers of renal injury are used to estimate the presence and extent of renal insult and various new are currently under trial. Traditional pharmacological interventions like dopamine, diuretics and calcium antagonists are not currently the first line of reno-protective agents. The new non-pharmacological and pharmacological methods may improve outcome in renal transplantation, contrast-induced nephropathy and in various other settings of ARF. The current review is an attempt to refresh the knowledge and put forth the various renal protectionstrategies during the peri-operative period.
KEYWORDS: Acute renal failure; acute tubular necrosis; nephrotoxins; peri-operative renal protection strategies; renal protection
Estrategias perioperatorias de protección renal en el trasplante hepático
Rosana Guerrero-Domínguez, Daniel López-Herrera Rodríguez, Jesús Acosta-Martínez, María Bueno-Pérez, Ignacio Jiménez
Nefrologia 2014;34(3):276-84
RESUMEN La insuficiencia renal es una de las complicaciones más comunes e importantes en los receptores de trasplante hepático. Se ha descrito que ocurre con una incidencia del 17 % al 95 %. Esta complicación se asocia a una estancia prolongada en la unidad de cuidados intensivos, necesidad de diálisis posoperatoria, complicaciones infecciosas, rechazo agudo y aumento de la mortalidad. Las causas de deterioro de la función renal difieren entre los períodos pre y posoperatorio. Mediante la identificación de los pacientes con riesgo de desarrollo de una insuficiencia renal aguda y la implantación precoz de estrategias de protección renal es posible frenar la progresión de disfunción renal y mejorar los resultados a largo plazo de los receptores de trasplante hepático. Palabras clave: Trasplante hepático. Lesión renal aguda. Toxicidad por los inhibidores de la calcineurina. Fallo renal. Biomarcadores renales. Terapias de protección renal.
Anestesia y Medicina del Dolor
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