RT Book, Section
A1 Beyene, Robel T.
A1 Miller, Richard S.
A1 Eastham, Shannon C.
A2 Feliciano, David V.
A2 Mattox, Kenneth L.
A2 Moore, Ernest E.
SR Print(0)
ID 1175136995
T1 Renal Failure
T2 Trauma, 9e
YR 2020
FD 2020
PB McGraw Hill
PP New York, NY
SN 9781260143348
LK accesssurgery.mhmedical.com/content.aspx?aid=1175136995
RD 2024/04/16
AB KEY  POINTSEighty-five  percent  of  renal  blood  flow  perfuses  the  outer  cortical  glomeruli,  whereas  the  remaining  15%  perfuses  the  juxtamedullary  glomeruli.The  final  concentration  and  volume  of  urine  vary  with  plasma  volume,  serum  osmolality,  release  of  antidiuretic  hormone  (ADH),  and  other  factors.Renal  failure  is  classified  by  the  RIFLE  (Risk,  Injury,  Failure,  Loss,  and  End  Stage),  AKIN  (Acute  Kidney  Injury  Network),  or  KDIGO  (Kidney  Disease:  Improving  Global  Outcomes)  systems.The  incidence  of  renal  failure  after  trauma  is  3%  to  9%.Causes  of  renal  failure  after  trauma  include  hemorrhage,  hypovolemia,  functional  prerenal  renal  failure,  toxins  (eg,  antibiotics),  contrast  nephropathy,  sepsis,  and  rhabdomyolysis.Current  KDIGO  guidelines  promote  the  use  of  isotonic  crystalloid  solutions  over  colloids  for  the  initial  volume  resuscitation  in  patients  at  risk  for  or  with  acute  kidney  injury.Overall  energy  use  is  not  affected  by  renal  failure  alone,  and  calorie  repletion  should  not  be  increased  based  solely  on  this  finding.Much  as  with  patients  with  chronic  kidney  disease,  indications  for  acute  renal  replacement  therapy  include  hyperkalemia  resistant  to  usual  therapy,  acidosis,  uremia,  and  severe  volume  overload.