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Related Concept Videos

Acute Kidney Injury I: Introduction01:22

Acute Kidney Injury I: Introduction

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Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
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Acute Kidney Injury II: Pathophysiology01:29

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Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
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Acute Kidney Injury VI: Nursing Management01:22

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Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...
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Acute Kidney Injury V: Interprofessional Care01:20

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Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
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Acute Kidney Injury III: Clinical Manifestations01:29

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Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
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Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

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Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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Ischemia-reperfusion Model of Acute Kidney Injury and Post Injury Fibrosis in Mice
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Acute kidney injury and intermediate-term renal function after clampless partial nephrectomy.

Naoko Kawamura1,2, Minato Yokoyama1, Hajime Tanaka1

  • 1Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.

International Journal of Urology : Official Journal of the Japanese Urological Association
|September 26, 2018
PubMed
Summary

Acute kidney injury (AKI) after clampless partial nephrectomy is uncommon and typically low-grade. This low-grade AKI does not appear to impact intermediate-term kidney function.

Keywords:
acute kidney injuryclamplesspartial nephrectomyrenal cell carcinomarenal function

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Area of Science:

  • Nephrology
  • Urology
  • Surgical Outcomes

Background:

  • Clampless partial nephrectomy is a surgical technique aimed at preserving renal function.
  • Acute kidney injury (AKI) is a potential complication following major surgery, including nephrectomy.
  • Understanding AKI incidence and long-term renal function after clampless partial nephrectomy is crucial for patient management.

Purpose of the Study:

  • To determine the incidence and predictors of AKI following clampless partial nephrectomy.
  • To assess the impact of AKI on intermediate-term renal function and identify risk factors for renal impairment.

Main Methods:

  • Retrospective analysis of 262 patients undergoing clampless partial nephrectomy (2010-2015).
  • Multivariate logistic regression to identify AKI predictors.
  • Evaluation of estimated glomerular filtration rate (eGFR) changes at 1 year and annually thereafter.
  • Assessment of postoperative renal impairment (≥25% eGFR decrease) over a median follow-up of 37 months.

Main Results:

  • The incidence of grade 1 AKI was 8.0%; no grade ≥2 AKI was observed.
  • High tumor complexity was the sole independent predictor of AKI.
  • Patients with AKI showed eGFR improvement within 1 year, with similar annual eGFR changes compared to those without AKI.
  • Advanced age and diabetes mellitus were risk factors for renal impairment, but AKI was not.

Conclusions:

  • Clampless partial nephrectomy is associated with a low incidence and severity of AKI.
  • Low-grade AKI following this procedure does not seem to adversely affect intermediate-term renal function.