No abstract

In-hospital survival rate of intensive care unit-admitted cirrhotic patients seemed acceptable, even in patients requiring life-sustaining treatments and/or with multiple organ failure on admission. The most important risk factor for in-hospital mortality was the severity of nonhematologic organ failure, as best assessed after 3 days. A trial of unrestricted intensive care for a few days could be proposed for select critically ill cirrhotic patients.

Clinicaltrials.gov Identifier NCT01449331.

No abstract

ClinicalTrials.gov identifier: NCT01818895.

IntroductionSeveral factors, including diuretic use and sepsis, interfere with the fractional excretion of sodium, which is used to distinguish transient from persistent acute kidney injury (AKI). These factors do not affect the fractional excretion of urea (FeUrea). However, there are conflicting data on the diagnostic accuracy of FeUrea.MethodsWe conducted an observational, prospective, multicenter study at three ICUs in university hospitals. Unselected patients, except those with obstructive AKI, were admitted to the participating ICUs during a six-month period. Transient AKI was defined as AKI caused by renal hypoperfusion and reversal within three days. The results are reported as medians (interquartile ranges).ResultsA total of 203 patients were included. According to our definitions, 67 had no AKI, 54 had transient AKI and 82 had persistent AKI. FeUrea was 39% (28 to 40) in the no-AKI group, 41% (29 to 54) in the transient AKI group and 32% (22 to 51) in the persistent AKI group (P = 0.12). FeUrea was of little help in distinguishing transient AKI from persistent AKI, with the area under the receiver operating characteristic curve being 0.59 (95% confidence interval, 0.49 to 0.70; P = 0.06). Sensitivity was 63% and specificity was 54% with a cutoff of 35%. In the subgroup of patients receiving diuretics, the results were similar.ConclusionsFeUrea may be of little help in distinguishing transient AKI from persistent AKI in critically ill patients, including those receiving diuretic therapy. Additional studies are needed to evaluate alternative markers or strategies to differentiate transient from persistent AKI.

E 1 0 2 7What ' s known on the subject? and What does the study add?The pathophysiology of post-renal acute kidney injury (PR-AKI), i.e. caused by urinary tract obstruction, has been extensively studied in animal models but clinical studies on this subject are outdated, and/or have focused on the mechanisms of ' post-obstructive diuresis ' (POD), a potentially life-threatening polyuria that can develop after the release of obstruction.In severe PR-AKI, the risk of occurrence of POD is high. POD occurrence predicts renal recovery without the persistence of severe chronic kidney failure. In the present study, the occurrence of POD and the persistence of chronic renal sequelae could be predicted early from clinical variables at admission before the release of obstruction. OBJECTIVE• To identify predictors of post-obstructive diuresis (POD) occurrence or severe chronic renal failure (CRF) persistence after the release of urinary tract obstruction in the setting of post-renal acute kidney injury (PR-AKI). PATIENTS AND METHODS• Bi-centre retrospective observational study of all patients with PR-AKI treated in two intensive care units (ICUs) from 1998 to 2010.• Clinical, biological and imaging characteristics on admission and after the release of obstruction were analysed with univariate and, if possible, multivariate analysis to search for predictors of (i) occurrence of POD (diuresis > 4 L/day) after the release of obstruction; (ii) persistence of severe CRF (estimated glomerular fi ltration rate < 30 mL/ min/1.73 m 2 , including end-stage CRF) at 3 months. RESULTS• On admission, median (range) serum creatinine was 866 (247 -3119) μ mol/L.• POD occurred in 34 (63%) of the 54 analysable patients. On admission, higher serum creatinine (Odds ratio [ OR ] 1.002 per 1 μ mol/L, 95% confi dence interval [ CI ] 1.000 -1.004, P = 0.004), higher serum bicarbonate (OR 1.36 per 1 mmol/L, 95% CI 1.13 -1.65, P < 0.001), and urinary retention (OR 6.96, 95% CI 1.34 -36.23, P = 0.01) independently predicted POD occurrence.• Severe CRF persisted in seven (21%) of the 34 analysable patients, including two (6%) cases of end-stage CRF. Predictors of severe CRF persistence after univariate analysis were: lower blood haemoglobin ( P < 0.001) and lower serum bicarbonate ( P = 0.03) on admission, longer time from admission to the release of obstruction ( P = 0.01) and absence of POD ( P = 0.04) after the release of obstruction. CONCLUSIONS• In severe PR-AKI treated in ICU, POD occurrence was a frequent event that predicted renal recovery without severe CRF.• POD occurrence or severe CRF persistence could be predicted early from clinical and biological variables at admission before the release of obstruction. KEYWORDSacute kidney failure , chronic kidney failure , ureteric obstruction , critical illness , polyuria Study Type -Therapy (case series) Level of Evidence 4

These results suggest that after brief focused training, intensive-care unit physicians without previous knowledge of ultrasonography can competently perform basic general ultrasonic examinations.