RESUMO
Haemofiltration and its variants are simple procedures which allow the management of patients with renal failure in intensive therapy units without the need for continual support from renal specialists. In order for non-renal specialists to manage the practical aspects of these treatments logically, safely and successfully it is important to understand the basic principles involved.
Assuntos
Injúria Renal Aguda/terapia , Hemofiltração/métodos , Anticoagulantes/administração & dosagem , Coagulação Sanguínea/efeitos dos fármacos , Protocolos Clínicos , Contraindicações , Cuidados Críticos , Humanos , Seleção de Pacientes , Fluxo Sanguíneo Renal EfetivoRESUMO
The decline in the use of acute peritoneal dialysis which has followed the recent advances in extracorporeal renal replacement therapy has left many clinicians unfamiliar with an invaluable therapeutic tool. This article is a timely reminder of both the underlying theory and the practical aspects of this technique.
Assuntos
Soluções para Diálise , Diálise Peritoneal/métodos , Cateteres de Demora , Glucose , Heparina/uso terapêutico , Humanos , Diálise Peritoneal/efeitos adversos , Cloreto de Potássio/uso terapêutico , Prática ProfissionalAssuntos
Injúria Renal Aguda/cirurgia , Anestesia Geral , Falência Renal Crônica/cirurgia , Equipe de Assistência ao Paciente , Injúria Renal Aguda/fisiopatologia , Cuidados Críticos , Humanos , Falência Renal Crônica/fisiopatologia , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Terapia de Substituição RenalRESUMO
Radionuclide gastric emptying studies were carried out on 20 patients with end-stage renal failure (ESRF) undergoing continuous ambulatory peritoneal dialysis (CAPD). Nine of the patients had diabetes mellitus. Eight normal volunteers were also studied to establish normal ranges. Solid and liquid emptying patterns were investigated simultaneously using a meal made up of a solid phase labelled with 99mTechnetium and a liquid phase labelled with 111Indium. The solid emptying fitted a model with a lag phase followed by a linear emptying phase and the liquid emptying fitted a single exponential. Nine of the 20 patients (four diabetic, five non-diabetic) were found to have delayed solid emptying, and four of these (two diabetic, two non-diabetic) also had delayed liquid emptying. No correlation was found between any of the parameters studied and the clinical symptoms of the patients. It is concluded that almost half of the patients studied had abnormal gastric emptying, but that many of these did not suffer from severe symptoms.
Assuntos
Esvaziamento Gástrico/fisiologia , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Nefropatias Diabéticas/diagnóstico por imagem , Nefropatias Diabéticas/fisiopatologia , Nefropatias Diabéticas/terapia , Feminino , Humanos , Radioisótopos de Índio , Falência Renal Crônica/diagnóstico por imagem , Masculino , Cintilografia , Tecnécio , Fatores de TempoRESUMO
Two hundred and fifty consecutive patients with acute renal failure treated by continuous haemofiltration on one intensive care unit (ICU) were studied prospectively to investigate the possibility of predicting outcome at the time of referral. Logistic regression analysis was used to identify important prognostic factors and the regression coefficients were used to weight a scoring system for the severity of illness of patients with acute renal failure. Overall survival was 53% with improvement over the course of the study. Multivariate analysis showed that outcome was related to age, need for artificial ventilation, use of inotropes, urine volume, serum bilirubin, arterial base deficit and serum creatinine. The scoring system based on the first five of these variables had a specificity of predicting death of 67% and a sensitivity of 76%.
Assuntos
Injúria Renal Aguda/terapia , Hemofiltração , Injúria Renal Aguda/sangue , Injúria Renal Aguda/mortalidade , Adulto , Fatores Etários , Bilirrubina/sangue , Creatinina/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Análise de Regressão , Respiração ArtificialRESUMO
Twelve patients with renal failure and type A lactic acidosis were treated with haemofiltration during a 30-month period. The first three patients received only lactate-buffered replacement fluid and rapidly succumbed despite the infusion of large quantities of sodium bicarbonate. Bicarbonate-buffered replacement fluid was used for the remaining nine patients, of whom three survived. Haemofiltration with bicarbonate-buffered replacement fluid is an effective method of replacing renal function for this group of critically-ill patients.
Assuntos
Acidose Láctica/terapia , Injúria Renal Aguda/terapia , Hemofiltração/métodos , Acidose Láctica/metabolismo , Acidose Láctica/mortalidade , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/metabolismo , Adolescente , Adulto , Idoso , Bicarbonatos/uso terapêutico , Criança , Estudos de Avaliação como Assunto , Hidratação/métodos , Hemofiltração/mortalidade , Humanos , Pessoa de Meia-IdadeRESUMO
The red-cell calcium concentration, measured by atomic absorption spectrophotometry, was found to be significantly higher in patients with end-stage renal failure than in healthy volunteers. This provides one possible explanation for some of the abnormalities of red-cell metabolism known to occur in uraemia.
Assuntos
Cálcio/sangue , Eritrócitos/análise , Falência Renal Crônica/sangue , Humanos , Diálise Renal/efeitos adversos , Espectrofotometria AtômicaAssuntos
Cálcio/sangue , Eritrócitos/análise , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espectrofotometria AtômicaRESUMO
Because water is freely exchangeable across most cell membranes, its distribution is largely determined by physical factors and by the relative osmolal concentrations of the extracellular and intracellular fluids. As the major extracellular cation, sodium is a principal determinant of the extracellular fluid volume.
