Early diagnosis and prevention of acute kidney injury in elderly patients after urgent abdominal surgery
| Autor: | N. V. Momot, S. I. Vorotyntsev, N. V. Tumanska, Yu.M. Petrenko |
|---|---|
| Rok vydání: | 2022 |
| Předmět: |
medicine.medical_specialty
education.field_of_study biology business.industry Population Acute kidney injury Renal function Perioperative urologic and male genital diseases medicine.disease female genital diseases and pregnancy complications Cystatin C Renal pathology Renal blood flow medicine biology.protein Intensive care medicine education business Abdominal surgery |
| Zdroj: | EMERGENCY MEDICINE. 17:46-55 |
| ISSN: | 2307-1230 2224-0586 |
| DOI: | 10.22141/2224-0586.17.5.2021.240707 |
| Popis: | Due to the rapidly aging of the population, the number of elderly patients is boosting. Elderly patients are a special cohort of patients due to their typical physiological and anatomical age-related changes, fragility, and comorbidity. One of the threatening perioperative complications is acute kidney injury (AKI), which is associated with a longer hospital stay, increased short-term and long-term mortality. Despite constant efforts to standardize the determination of AKI using serum creatinine, this method has several disadvantages, which makes the search for other diagnostic criteria for kidney damage urgent. Recently, the determination of biomarkers (lipocalin-2, interleukin-18, cystatin C), which can be useful in the early diagnosis of AKI, has become increasingly popular. Even though the filtration capacity of the kidneys is the only factor determining the serum cystatin C concentration, this marker is the most valuable. The use of ultrasound for the early diagnosis of AKI is also considered promising. Several studies show that the renal resistance index and semi-quantitative assessment of renal blood flow work are well for diagnosing persistent AKI. The high mortality rate and the lack of special treatment increase the need for AKI prevention in the elderly, the main one of which is careful clinical monitoring with timely correction of hypovolemia and hypotension. With invasive procedures, the risk of AKI can be reduced by maintaining mean arterial pressure > 80 mmHg and hematocrit > 30 %, as well as providing adequate oxygenation and volume restoration. Prescription of drugs should be individualized by adjusting doses based on the glomerular filtration rate and the patient’s age. However, the question of specific drug prevention of AKI remains open. Several studies have confirmed the renoprotective properties of dexmedetomidine in cardiac surgery, and some positive effects of pentoxifylline for the treatment of renal pathology are also described in the literature. This review explores the topic of AKI in elderly patients undergoing abdominal surgery and focuses on the early diagnosis and prevention of this syndrome. |
| Databáze: | OpenAIRE |
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