RESULTS: Novel
biomarkers such as
cystatin C and
neutrophil gelatinase-associated lipocalin (NGAL) are being investigated to replace serum
creatinine in the detection of AKI. Recent studies suggest that intravenous (IV) fluid use is beneficial for the prevention of contrast-induced AKI, while
N-acetylcysteine use is not as well established.
Diuretics are clearly beneficial in the treatment of acute decompensated
heart failure. Ultrafiltration is less promising and can lead to adverse side effects. Although
terlipressin use in
hepatorenal syndrome is associated with reduced mortality, it is not available in the United States; combination
therapy with
midodrine,
octreotide, and
albumin provides an alternative. Fluid
resuscitation is frequently used in
critically ill patients with AKI; however, overly aggressive fluid
resuscitation is frequently associated with an increased risk of mortality. A 3-step approach that combines guided fluid
resuscitation, establishment of an even fluid balance, and an appropriate rate of fluid removal may be beneficial. If fluid
resuscitation is needed,
crystalloid solutions are preferred over
hetastarch solutions.
Renal replacement therapy is the last resort in AKI treatment, and timing, modality, and dosing are discussed. Research suggests that AKI leads to an increased incidence of subsequent
chronic kidney disease. However, this relationship has not been fully established and additional studies are needed for clarification.
CONCLUSION: