44 Acute Renal Failure	359

¥Once a patient is considered to be in failure according to this criterion, the issue of renal replacement therapy arises, and early nephrology consultation is useful.

¥Serum and urinary biomarkers like NGAL (neutrophil gelatin-associated lipocalin) have been found to be useful in early detection of AKI.

Limitations of using these parameters for differentiating prerenal from renal

injury: use of diuretics, postcontrast i.v. contrast, CKD, elderly, acute glomerulonephritis, acute interstitial nephritis, hyperglycemia, and hepatorenal syndrome.

Suggested Reading

1.Acute Dialysis Quality Initiative (ADQI) consensus group. ADQI 7: the clinical management of the cardio-renal syndromes: work group statements from the 7th ADQI consensus conference. Nephrol Dial Transpl. 2010;25(7):2077Ð89.

A comprehensive review on this increasingly recognized clinical entity. Many patients with heart failure have underlying renal dysfunction, and similarly, patients with kidney failure are prone to cardiac failure. This has led to the concept of cardiorenal syndromes, which can be an acute or chronic cardiorenal syndrome, when cardiac failure causes deterioration in renal function, or acute and/or chronic renicardiac syndrome, when renal dysfunction leads to cardiac failure. These patients have typically been excluded from clinical trials.

2.Crowley ST, Peixoto AJ. Acute kidney injury in the intensive care unit. Clin Chest Med. 2009;30(1):29Ð43.

This review focuses on the diagnosis and management of AKI.

3.Bagshaw SM, Delaney A, Haase M, Ghali WA, Bellomo R. Loop diuretics in the management of acute renal failure: a systematic review and meta-analysis. Crit Care Resusc. 2007;9(1):60Ð8.

Review of literature on the subject

4.Bellomo R. DeÞning, quantifying, and classifying acute renal failure. Crit Care Clin. 2005;21(2): 223Ð37.

A comprehensive review article on the subject

5.Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute Dialysis Quality Initiative workgroup. Acute renal failureÑdeÞnition, outcome measures, animal models, ßuid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204Ð12.

This article enunciates the RIFLE criteria, which has given us an early practical way of diagnosing AKI, which is internationally accepted and validated in various countries and scenarios.

Websites

1.www.renalandurologynews.com

A comprehensive site for clinical trial summary on AKI

2.www.ADQI.net

Homepage for RIFLE criteria network

3.www.kidneycare.nhs.uk

A site for information on preventive aspects of AKI