Volume resuscitation and management

Adequate fluid balance and good renal perfusion must be targeted in critically ill patients to reduce the risks of developing acute renal failure. Fluid resuscitation and management are complicated in acute renal failure, and these patients must be carefully and closely monitored. No intravenous fluid is perfect, and fluid choices should be based on individual patient's requirements. © Springer-Verlag Berlin Heidelberg 2010.SCOPUS: ch.binfo:eu-repo/semantics/publishe

Proteinuria and hematuria are associated with acute kidney injury and mortality in critically ill patients: a retrospective observational study

BACKGROUND: Proteinuria and hematuria are both important health issues; however, the nature of the association between these findings and acute kidney injury (AKI) or mortality remains unresolved in critically ill patients. METHODS: Proteinuria and hematuria were measured by a dipstick test and scored using a scale ranging from a negative result to 3+ in 1883 patients admitted to the intensive care unit. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The odds ratios (ORs) for AKI and 3-year mortality were calculated after adjustment for multiple covariates according to the degree of proteinuria or hematuria. For evaluating the synergistic effect on mortality among proteinuria, hematuria, and AKI, the relative excess risk due to interaction (RERI) was used. RESULTS: Proteinuria and hematuria increased the ORs for AKI: the ORs of proteinuria were 1.66 (+/−), 1.86 (1+), 2.18 (2+), and 4.74 (3+) compared with non-proteinuria; the ORs of hematuria were 1.31 (+/−), 1.58 (1+), 2.63 (2+), and 2.52 (3+) compared with non-hematuria. The correlations between the mortality risk and proteinuria or hematuria were all significant and graded (Ptrend < 0.001). There was a relative excess risk of mortality when both AKI and proteinuria or hematuria were considered together: the synergy indexes were 1.30 and 1.23 for proteinuria and hematuria, respectively. CONCLUSIONS: Proteinuria and hematuria are associated with the risks of AKI and mortality in critically ill patients. Additionally, these findings had a synergistic effect with AKI on mortality