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Tuesday, September 27, 2016

Sepsis-Associated AKI

PulmCCM
PulmCrit - September 25, 2016 - By JE
8320699_s
..."If the underlying abnormality in early, septic renal dysfunction is microvascular, it calls for a reappraisal of macrovascular, goal-directed therapies. Rather than giving excessive, chloride-containing crystalloids, it may be of merit to focus on the pressure within the glomerulus [Pgc]. Raising mean arterial pressure with norepinephrine should help increase Pgc, but also avoiding things that constrict the afferent arteriole [e.g. NSAIDs, excessive chloride]. Further, there may be benefit to increasing the resistance of the efferent arteriole; this too would raise Pgc. Means to accomplish this are the administration of vasopressin orintravenous angiotensin II – which has been recently evaluated. In the recently-published VANISH Trial - which compared vasopressin to norepinephrine in early septic shock - vasopressin was associated with a 10% absolute decrease in the need for renal replacement therapy.
For more information on management, please read this excellent post by Josh Farkas on this topic [which includes a link to Dr. Bellomo’s must-watch grand rounds on his data] and Josh's excellent review of VANISH."