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INSUFICIENCIA RENAL AGUDA ASOCIADA CON SEPSIS

INSUFICIENCIA RENAL AGUDA ASOCIADA CON SEPSIS

(especial para SIIC © Derechos reservados)
Se describe la incidencia de insuficiencia renal aguda en los sujetos sépticos, los factores clínicos y bioquímicos comórbidos, los focos de origen, la necesidad de hemodiálisis, la tasa de mortalidad, la de supervivencia del paciente y de recuperación de la función renal
Autor:
Fernando Lombi
Columnista Experto de SIIC

Institución:
Hospital Británico


Artículos publicados por Fernando Lombi
Coautor
Hernán Trimarchi* 
Hospital Británico, Buenos Aires, Argentina*
Recepción del artículo
28 de Agosto, 2012
Aprobación
10 de Octubre, 2012
Primera edición
23 de Noviembre, 2012
Segunda edición, ampliada y corregida
3 de Febrero, 2014

Resumen
La insuficiencia renal aguda asociada con sepsis (IRAS) es un cuadro potencialmente mortal, en especial cuando forma parte del síndrome de disfunción multiorgánica (SDMO). La información con que se cuenta demuestra que la sepsis y el shock séptico son las causas más frecuentes de insuficiencia renal aguda (IRA) en pacientes críticamente enfermos, lo que provoca una alta morbimortalidad. En los últimos años ha cambiado el perfil de los pacientes a los cuales se destinan las terapias de reemplazo renal (TRR) en la IRAS, se trata de pacientes ancianos, con múltiples factores de riesgo y asociados con SDMO. Si bien no existe ventaja alguna en términos de mortalidad entre las terapias continuas y las intermitentes, los datos demostraron que la instauración precoz de TRR mejoraba el pronóstico. Otro punto sin consenso es el de la intensidad de esta terapia. Debido a que la sepsis es un estado hipercatabólico que se acompaña de un gran equilibrio positivo, el aumento en la intensidad de ésta plantea un paradigma racional con el objetivo de atenuar los desequilibrios iniciales. En un estudio prospectivo, observacional y longitudinal sobre 80 pacientes internados en una unidad de cuidados intensivos (UCI), se analizó la evolución de IRA según los valores de creatinina (Cr) al ingreso en pacientes críticos con sepsis grave, y su relación con la mortalidad y demás parámetros de laboratorio. Asimismo, se evaluó la relación de la IRAS y la intensidad de la TRR en estos pacientes. No obstante, recientemente se ha investigado la capacidad de las TRR como terapias inmunomoduladoras o "terapias puente", para que éstas no se limiten sólo a eliminar productos de desecho del metabolismo, sino que permitan además la recuperación de la función renal mientras se mantiene la homeostasis, con el fin de lograr así disminuir la morbimortalidad de estos pacientes.

Palabras clave
injuria, insuficiencia renal aguda, sepsis


Artículo completo

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Extensión:  +/-5.82 páginas impresas en papel A4
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Abstract
Acute kidney injury (AKI) associated with sepsis is a potentially fatal complication, especially as part of multiorgan dysfunction syndrome (MODS). Evidence shows that sepsis and septic shock are common causes of AKI in critically ill patients, with high morbi-mortality.
In recent years, the profile of septic patients who require renal replacement therapy (RRT) has changed. These patients are elderly and with multiple risk factors and associated MODS. While there is no advantage in terms of mortality between intermittent vs. continuous therapies, the early start of RRT appears to improve prognosis. Another unanswered issue is the lack of consensus on the dose of RRT. Sepsis remains a hypercatabolic state accompanied by a large positive balance and the increase in the intensity of dose RRT is a rational paradigm in order to mitigate the initial metabolic and fluid imbalances.
In a prospective, observational, longitudinal study on 80 patients admitted to our intensive care unit (ICU), due to severe sepsis, we studied the development of AKI using the creatinine (Cr) as a marker and its relationship to mortality and other laboratory parameters. Furthermore, we evaluated the association between the development of infections and the intensity of the TRR delivered to these patients.
However we have assesed, the TRR as a immunomodulatory treatment, working as a "bridge therapy" and not only confined so as to sweep waste catabolic products of metabolism, contributory to the recovery of renal function while maintaining the homeostasis and improving reducing morbidity and mortality score of these patients.

Key words
acute kidney injury, injury, sepsis


Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Cuidados Intensivos, Nefrología y Medio Interno
Relacionadas: Bioquímica, Diagnóstico por Laboratorio, Infectología, Medicina Interna



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Hernán Trimarchi, Hospital Británico, 1280AEB, Perdriel 74, Buenos Aires, Argentina
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