Prevention of acute kidney injury and protection of renal function in the intensive care unit

Acute renal failure on the intensive care unit is associated with significant mortality and morbidity. To determine recommendations for the prevention of acute kidney injury (AKI), focusing on the role of potential preventative maneuvers including volume expansion, diuretics, use of inotropes, vasopressors/vasodilators, hormonal interventions, nutrition, and extracorporeal techniques. A systematic search of the literature was performed for studies using these potential protective agents in adult patients at risk for acute renal failure/kidney injury between 1966 and 2009. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, and use of potentially nephrotoxic drugs and radiocontrast media. Where possible the following endpoints were extracted: creatinine clearance, glomerular filtration rate, increase in serum creatinine, urine output, and markers of tubular injury. Clinical endpoints included the need for renal replacement therapy, length of stay, and mortality. Studies are graded according to the international Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) group system Several measures are recommended, though none carries grade 1A. We recommend prompt resuscitation of the circulation with special attention to providing adequate hydration whilst avoiding high-molecular-weight hydroxy-ethyl starch (HES) preparations, maintaining adequate blood pressure using vasopressors in vasodilatory shock. We suggest using vasopressors in vasodilatory hypotension, specific vasodilators under strict hemodynamic control, sodium bicarbonate for emergency procedures administering contrast media, and periprocedural hemofiltration in severe chronic renal insufficiency undergoing coronary intervention

Numerical Analysis of Arterial Plaque Thickness and its Impact on Artery Wall Compliance

Cardiovascular disease is a major cause of mortality throughout the world. The history of cardiovascular research is rich and although this study is not intended to be a review of the subject, a short summary related to the present work is necessary. Interested readers are invited to review articles such as [1-4]. These studies are representative of the literature which deal with the complexities of hemodynamics. Among the important subtopics are the relationship between the wall and the fluid. The fluid exerts a shear stress on the wall which is believed to be a causing of thickening of the wall and the initiation of cardiovascaular disease. The flow also has an impact on transport through the arterial wall [5-20].In addition to these hemodynamic-focused studies, it has been found that arterial compliance (the distension of an artery wall during the cardiac cycle) is an important indicator of disease progression. In particular, for a diseased artery, the stiffened arterial wall or the rigid plaque layer reduces the otherwise healthy-artery response to pressure fluctuations [21-22]. In addition, the presence of a stenosis can affect the blood velocity profile [21-26] which can be measured Doppler or ultrasound techniques [27-37].</p