This Clinical Practice Guideline document is based upon systematic literature searches last conducted in June 2011, supplemented with additional evidence through November 2012. It is designed to provide information and assist decision making. It is not intended to define a standard of care, and should not be construed as one, nor should it be interpreted as prescribing an exclusive course of management. Variations in practice will inevitably and appropriately occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every health-care professional making use of these recommendations is responsible for evaluating the appropriateness of applying them in any particular clinical situation. The recommendations for research contained within this document are general and do not imply a specific protocol.
SECTION II: DISCLOSUREKidney Disease: Improving Global Outcomes (KDIGO) makes every effort to avoid any actual or reasonably perceived conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the Work Group. All members of the Work Group are required to complete, sign, and submit a disclosure and attestation form showing all such relationships that might be perceived as or are actual conflicts of interest. This document is updated annually and information is adjusted accordingly. All reported information is published in its entirety at the end of this document in the Work Group members' Biographic and Disclosure Information section, and is kept on file at the National Kidney Foundation (NKF), former Managing Agent for KDIGO.http://www.kidney-international.org
Acute acalculous cholecystitis developed in 16 of 92 patients with acute renal failure who had no prior or coincidental biliary tract disease. The cause of this complication is considered to be multifactorial. Risk factors include sepsis, previous surgery, trauma, total parential nutrition, intermittent positive pressure ventilation, opiate sedation, multiple transfusions and hypotension. One patient had 5 risk factors, 15 had 6 or more. Diagnosis was based on clinical suspicion, serial ultrasound scanning and serial estimations of white cell count, liver function and C-reactive protein. Four patients were treated conservatively with antibiotics and ultrasound observation, 10 underwent cholecystotomy and 2 patients had cholecystectomy. Eleven patients survived (69% survival). No patient treated by cholecystotomy required further surgery to the biliary tract. Acute acalculous cholecystitis has become a significant complication in our "high risk" acute renal failure population as intensive care has advanced and patients are surviving longer. Prompt and appropriate treatment will prevent it contributing significantly to the already high mortality of acute renal failure. Anticipation is the watchword.
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