There is growing interest in quantitative physical chemical analysis of acid-base physiology among intensivists. Acid-base dilemmas seen in the intensive care unit are not always well addressed by the traditional approaches. Quantitative physical chemical analysis also allows for the exploration of unexplained anion-induced acidosis where the familiar anion gap is insufficient or inaccurate. This approach emphasizes the application of accepted physical chemical principles and identification of independent and dependent acid-base variables. In aqueous solutions, water dissociation is the major source of free hydrogen ions.
{"title":"Metabolic acidosis in the critically ill: lessons from physical chemistry.","authors":"J A Kellum","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>There is growing interest in quantitative physical chemical analysis of acid-base physiology among intensivists. Acid-base dilemmas seen in the intensive care unit are not always well addressed by the traditional approaches. Quantitative physical chemical analysis also allows for the exploration of unexplained anion-induced acidosis where the familiar anion gap is insufficient or inaccurate. This approach emphasizes the application of accepted physical chemical principles and identification of independent and dependent acid-base variables. In aqueous solutions, water dissociation is the major source of free hydrogen ions.</p>","PeriodicalId":17704,"journal":{"name":"Kidney international. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20495028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite the wide number of diseases currently or previously treated with plasma exchange and plasmapheresis, the clinical effectiveness of these treatments has been established by large, controlled clinical trials only in few clinical conditions. The firmly accepted and the possible indications for these techniques in critically ill patients are reviewed and discussed, as well as their complications and possible side effects.
{"title":"Plasmapheresis in the critically ill patient.","authors":"G Berlot, A Tomasini, L Silvestri, A Gullo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Despite the wide number of diseases currently or previously treated with plasma exchange and plasmapheresis, the clinical effectiveness of these treatments has been established by large, controlled clinical trials only in few clinical conditions. The firmly accepted and the possible indications for these techniques in critically ill patients are reviewed and discussed, as well as their complications and possible side effects.</p>","PeriodicalId":17704,"journal":{"name":"Kidney international. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20496208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acute renal failure as a part of multiple organ failure: the slippery slope of critical illness.","authors":"D Breen, D Bihari","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":17704,"journal":{"name":"Kidney international. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20493845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Critical care nephrology: the time has come.","authors":"C Ronco, R Bellomo, M Feriani, G La Greca","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":17704,"journal":{"name":"Kidney international. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20493841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute renal failure (ARF) in the critical care setting is defined as the abrupt decline in glomerular filtration rate (GFR) resulting from ischemic or toxic injury to the kidney. ARF is often only one of several organ-system failures that are present in this patient population. Recent evidence suggests that there are four major factors that are the most important in the initiation and maintenance of ARF. These include a decrease of glomerular capillary permeability, back-leak of glomerular filtrate, tubular obstruction, and intrarenal vasoconstriction. Both sub-lethal and lethal cell injury have been found in ARF, with the latter related either to necrosis or apoptosis. Intrarenal vasoconstriction, related to a shift in the balance between endothelin and endothelium-derived nitric oxide, is receiving considerable attention as a major contributor to the pathogenesis of ARF, with therapeutic maneuvers targeted at restoring the usual balance, and relieving intrarenal vasoconstriction. If such approaches prove to be of value, the outcome of patients with this serious condition might be substantially improved.
{"title":"Acute renal failure: definition and pathogenesis.","authors":"A R Nissenson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Acute renal failure (ARF) in the critical care setting is defined as the abrupt decline in glomerular filtration rate (GFR) resulting from ischemic or toxic injury to the kidney. ARF is often only one of several organ-system failures that are present in this patient population. Recent evidence suggests that there are four major factors that are the most important in the initiation and maintenance of ARF. These include a decrease of glomerular capillary permeability, back-leak of glomerular filtrate, tubular obstruction, and intrarenal vasoconstriction. Both sub-lethal and lethal cell injury have been found in ARF, with the latter related either to necrosis or apoptosis. Intrarenal vasoconstriction, related to a shift in the balance between endothelin and endothelium-derived nitric oxide, is receiving considerable attention as a major contributor to the pathogenesis of ARF, with therapeutic maneuvers targeted at restoring the usual balance, and relieving intrarenal vasoconstriction. If such approaches prove to be of value, the outcome of patients with this serious condition might be substantially improved.</p>","PeriodicalId":17704,"journal":{"name":"Kidney international. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20493843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pathogenesis of renal failure in sepsis.","authors":"A Thijs, L G Thijs","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":17704,"journal":{"name":"Kidney international. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20493846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Synthetic high-flux dialyzer membranes used in continuous veno-venous hemofiltration are permeable to middle molecular size endogenous pyrogens, the pro-inflammatory cytokines IL-1 beta and TNF-alpha. The quantities removed by sieving are, however, negligible in vitro as well as in vivo. Adsorption of cytokines to the membrane polymer is the major mechanism of pyrogen removal. Adsorption seems to be semispecific for pro-inflammatory cytokines because levels of anti-inflammatory mediators were not changed or even increased during CVVH. Thus, CVVH may change cytokine profiles in septic patients supporting the predominance of anti-inflammatory over pro-inflammatory activity in plasma. It remains to be demonstrated whether modifications of extracorporeal blood purification systems (high-volume CVVH, plasma separation + adsorption) are able to amplify the change in cytokine profiles and whether this change influences outcome of septic patients.
{"title":"Transfer of endogenous pyrogens across artificial membranes?","authors":"G Lonnemann, S Linnenweber, M Burg, K M Koch","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Synthetic high-flux dialyzer membranes used in continuous veno-venous hemofiltration are permeable to middle molecular size endogenous pyrogens, the pro-inflammatory cytokines IL-1 beta and TNF-alpha. The quantities removed by sieving are, however, negligible in vitro as well as in vivo. Adsorption of cytokines to the membrane polymer is the major mechanism of pyrogen removal. Adsorption seems to be semispecific for pro-inflammatory cytokines because levels of anti-inflammatory mediators were not changed or even increased during CVVH. Thus, CVVH may change cytokine profiles in septic patients supporting the predominance of anti-inflammatory over pro-inflammatory activity in plasma. It remains to be demonstrated whether modifications of extracorporeal blood purification systems (high-volume CVVH, plasma separation + adsorption) are able to amplify the change in cytokine profiles and whether this change influences outcome of septic patients.</p>","PeriodicalId":17704,"journal":{"name":"Kidney international. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20493848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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