Kidney
Renal dysfunction in MODS is reflected in impairment of normal selective excretory function, initially in oliguria despite adequate intravascular volume, but later in a rising creatinine level, and fluid and electrolyte derangements of sufficient magnitude that dialysis is required. Its causes are both pre-renal and renal. Reduced renal blood flow secondary to systemic hypotension, altered regional perfusion, or increased intra-abdominal pressure is an early risk factor; evolution of the disorder is compounded by pre-existing physiologic deficit and the effects of nephrotoxic drugs. Obstructive causes must be considered and ruled out. As is the case for lung injury, ICU interventions contribute to the evolution of the syndrome: vasopressor agents cause further reductions in renal blood flow, while potentially nephrotoxic drugs are a key part of the anti-infective arsenal used in the ICU.
Kidney
Renal dysfunction in MODS is reflected in impairment of normal selective excretory function, initially in oliguria despite adequate intravascular volume, but later in a rising creatinine level, and fluid and electrolyte derangements of sufficient magnitude that dialysis is required. Its causes are both pre-renal and renal. Reduced renal blood flow secondary to systemic hypotension, altered regional perfusion, or increased intra-abdominal pressure is an early risk factor; evolution of the disorder is compounded by pre-existing physiologic deficit and the effects of nephrotoxic drugs. Obstructive causes must be considered and ruled out. As is the case for lung injury, ICU interventions contribute to the evolution of the syndrome: vasopressor agents cause further reductions in renal blood flow, while potentially nephrotoxic drugs are a key part of the anti-infective arsenal used in the ICU.
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