Book contents
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- SECTION 1 Admission to Critical Care
- SECTION 2 General Considerations in Cardiothoracic Critical Care
- SECTION 3 System Management in Cardiothoracic Critical Care
- 3.1 CARDIOVASCULAR SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.2 RESPIRATORY SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.3 RENAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 29 Renal protection and cardiac surgery
- 30 Renal replacement therapy
- 3.4 HAEMATOLGY AND TRANSFUSION IN CARDIOTHORACIC CRITICAL CARE
- 3.5 GASTROINTESTINAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.6 IMMUNE SYSTEM AND INFECTION IN CARDIOTHORACIC CRITICAL CARE
- 3.7 ENDOCRINE SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.8 NEUROLOGICAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- SECTION 4 Procedure-Specific Care in Cardiothoracic Critical Care
- SECTION 5 Discharge and Follow-up From Cardiothoracic Critical Care
- SECTION 6 Structure and Organisation in Cardiothoracic Critical Care
- SECTION 7 Ethics, Legal Issues and Research in Cardiothoracic Critical Care
- Appendix Works Cited
- Index
29 - Renal protection and cardiac surgery
from 3.3 - RENAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
Published online by Cambridge University Press: 05 July 2014
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- SECTION 1 Admission to Critical Care
- SECTION 2 General Considerations in Cardiothoracic Critical Care
- SECTION 3 System Management in Cardiothoracic Critical Care
- 3.1 CARDIOVASCULAR SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.2 RESPIRATORY SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.3 RENAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 29 Renal protection and cardiac surgery
- 30 Renal replacement therapy
- 3.4 HAEMATOLGY AND TRANSFUSION IN CARDIOTHORACIC CRITICAL CARE
- 3.5 GASTROINTESTINAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.6 IMMUNE SYSTEM AND INFECTION IN CARDIOTHORACIC CRITICAL CARE
- 3.7 ENDOCRINE SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.8 NEUROLOGICAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- SECTION 4 Procedure-Specific Care in Cardiothoracic Critical Care
- SECTION 5 Discharge and Follow-up From Cardiothoracic Critical Care
- SECTION 6 Structure and Organisation in Cardiothoracic Critical Care
- SECTION 7 Ethics, Legal Issues and Research in Cardiothoracic Critical Care
- Appendix Works Cited
- Index
Summary
Introduction
There is a wide spectrum of severity of acute renal dysfunction after cardiac surgery, ranging from subclinical renal injury to acute renal failure (ARF) requiring renal replacement therapy. The incidence of ARF following cardiac surgery varies depending on the definition, but approximately 5% of cardiac surgical patients require renal replacement for ARF. Acute renal failure is a serious complication; it is associated with increased mortality and prolonged critical care unit and hospital stays.
Measurement of renal function
Although serum creatinine and urine output lack sensitivity and specificity in renal dysfunction, these indices are the most easily measured in clinical practice. Measurement of glomerular filtration rate by creatinine clearance is less straightforward and is of limited value in the absence of steady-state conditions. Other tests of renal function are of questionable clinical use; newer biomarkers are under evaluation and may have greater sensitivity for detecting renal dysfunction.
Definition of acute renal failure
Until recently, there has been no consensus on the optimal measurement of renal function or the definition of ARF. An international interdisciplinary collaborative group, the Acute Dialysis Quality Initiative, has formulated a standard definition of acute renal dysfunction, a term that encompasses the range of abnormalities of renal function. The acronym RIFLE defines three grades of increasing severity of acute renal dysfunction (risk; injury; failure) and two outcome variables (loss; end stage).
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- Core Topics in Cardiothoracic Critical Care , pp. 223 - 229Publisher: Cambridge University PressPrint publication year: 2008