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28 - A Nephrology Consult

from SECTION IV - MANAGEMENT OF MEDICAL DISORDERS IN THE NEUROCRITICAL CARE UNIT

Published online by Cambridge University Press:  27 April 2010

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Summary

A nephrology consult could be requested for numerous reasons, many of which are beyond the scope of this chapter, but only the relatively small list that bears on the urgent and emergent issues related to patient management in the neuro-intensive care unit (NICU) is addressed in this chapter. These include diagnosis and management of renal failure (both acute and chronic), electrolyte disorders, and acid-base disorders. In particular, it is important to note that early involvement of a nephrologist has been shown to improve morbidity and mortality in acute kidney injury (also known as acute renal failure) in intensive care unit (ICU) patients, even when dialysis was not required. The following sections briefly summarize the critical issues associated with each of these categories of disease and the key features in initial management.

RENAL FAILURE

The majority of nephrology consults in any ICU setting are for acute kidney injury (AKI). Although it is usually caused by physiologic disturbances related to other medical conditions, AKI is associated with mortality in excess of 50% in ICU patients (depending on concurrent illnesses), and it carries an independent risk for death in those afflicted. Early recognition and appropriate treatment of contributing factors are important in improving outcomes. In contrast, chronic kidney disease (CKD) in the ICU setting is an important modifier of patient management decisions, but does not have nearly as great an impact on outcomes as AKI. Most CKD cases are caused by diabetes mellitus and hypertension, but it not useful to review the myriad factors involved because the cause of CKD has little influence on management.

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Neurocritical Care , pp. 381 - 396
Publisher: Cambridge University Press
Print publication year: 2009

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