expo-diagnosis and management of acute kidney injury in
TRANSCRIPT
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Diagnosis and manageme
of acute kidney injury inpatients with cirrosis:Revised consensus
recommendations of theInternational Club of Ascit
PISCO ZAVAL
QUEZADA MOKARIN
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C%"&e%"os D"a7n#s&"cos 'e AKI > sua!"cac"#n en ac"en&es con c"%%os
AKI es !a %e'ucc"#n s"7n"5ca&"3a a7u'a en !a TF?(
C%s es e! 4"oma%ca'o% m@s %@c&"co a%a e3a!ua% !a $unc"#n %ena! en ac"en&ec"%%os"s-(
Pe%o(((C%s &"ene !"m"&ac"ones en !a %@c&"ca c!n"ca o%ue.
Inuenc"a'o. , Raa, E'a', ?ene%o
Pac"en&es con c"%%os"s.
D"sm"nuc"#n en !a $o%mac"#n 'e c%ea&"n"na, secun'a%"a a !a %'muscu!a%(
Aumen&o 'e !a sec%ec"#n &u4u!a% 'e C%
Aumen&o 'e !a '"s&%"4uc"#n 'e! 3o!umen en !a c"%%os"s. C%s '"!u"'a
In&e%$e%enc"a con !os ensa>os C%s o% n"3e!es e!e3a'os 'e 4"!"%%u4
Como consecuenc!a C%s en ac"en
so4%ees&"ma !a TF
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E! uso 'e un um4%a! 5Go 'e C%s en *(0 m78'! a%a 'e5n"% AKI en !a c"%%os%o4!em@&"co(
*( E! 3a!o% 'e C%s *(0 m78'!, a menu'o s"7n"5ca ue !a TF? '"sm"nu>eno&a4!emen&e( )91m!8m"n-
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S"n em4a%7o, e! uso 'e una %e'ucc"#n 'e !a %o'ucc"#n 'e o%"na en
con c"%%os"s > asc"&"s como c%"&e%"o 'e '"a7n#s&"co es un %o4!emes&os ac"en&es son con $%ecuenc"a o!"7=%"cos con %e&enc"#n 'e soaun man&ene% una TFR no%ma! o ue'en &ene% un aumen&o 'e 'e4"'o a un &%a&am"en&o '"u%&"co(
Po% !o &an&o, !a %eco!ecc"#n 'e o%"na es a menu'o "neac&a en c!n"ca > e! uso 'e !os cam4"os c"n&"cos en SCR se con3"e%&e ec%uc"a! 'e !a 'e5n"c"#n a%a e! '"a7n#s&"co 'e !a !es"#n %ena! ac"%%os"s(
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)or *u+ necesitamos cambiar los criterios de diagn,
convencionales para A-I.
En !a ac&ua!"'a', !os es&u'"os so4%e e! IRA en ac"en&es con cmos&%# ue !a IRA se 'e5ne o% un "nc%emen&o a4so!u&o en sCRm7 8 '! ) 8 o J012 'e! 3a!o% "n"c"a! es&a asoc"a'una ma>o% %o4a4"!"'a' 'e !os ac"en&es sean &%ans$e%"'os a !a 'e cu"'a'os "n&ens"3os, es&anc"a ;os"&a!a%"a mas !a%7a > !a mo%&a me'"o !ao(
So4%e !a 4ase 'e es&a e3"'enc"a, &o'os !os ee%&os co"nc"'"e%on ee%a e! momen&o 'e cam4"a% nues&%a 'e5n"c"#n ac&ua! 'e !a "nsu5c%ena! me'"an&e !a "n&%o'ucc"#n 'e una 3e%s"#n mo'"5ca'a 'c%"&e%"os KDI?O a%a e! '"a7n#s&"co 'e !es"#n %ena! a7u'a en ac
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/0nea de base de la creatinina s+rica padiagn,stico de A-I
•
De1nir una l0nea de base sCr
An&es 'e !a a'm"s"#n
meses o * ao an&esHHH)4ase %emo% Con'"c"#n "'ea!. 3a!o% 'e !a SCR sea
an&es 'e! "n7%eso )"n3"a4!e- E! 3a!o% sC% 9 meses an&es 'e !a a'm"s
mas $ac&"4!e IRA ue'e se% '"a7nos&"ca'a cuan'o e
SCR J012 'e! =!&"mo 3a!o% SCR
A'u"%"'a en !a co
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En o 'esus !a a'm"s"#n A'u"%"'a en e! ;os"&
T"emo mas %"7u%oso Uso 'e '"u%&"cos a$ec&a !a $unc"#n %ena! Va%"a4"!"'a' 'e !a4o%a&o%"o a !a4o%a&o%"o o
m"smo !a4o%a&o%"o A!"cac"#n "n3e%sa $o%mu!a MDRD u&"!"a u
TF? )Ineac&a en ac"en&es c"%%#&"cos, asc
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$ema De1nici,n
/0nea de base sCr Un 3a!o% 'e sC% o4&en"'a en !os 9 meses an&e%"o%es , cuan'o es& '"soncomo 4ase 'e %e$e%enc"a sC%( En !os ac"en&es con m@s 'e un 3a!o% 'an&e%"o%es , se 'e4e u&"!"a% e! 3a!o% m@s ce%cano a! &"emo 'e "n7%eso en
En !os ac"en&es s"n un 3a!o% sC% an&e%"o%, e! sC% en !a a'm"s"#n se 'e4e4ase (
De1nici,n de IRA • Aumen&o en sC% / 1,9 m7 8 '! )/
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8anejo de la IRA en pacientes ccirrosis
*( La %e3"s"#n 'e ;"s&o%"as 'e '%o7as Su%es"#n 'e! &%a&am"en&o con '"u%&"cos Su%es"#n 'e Ne$%o"cos Re&"%a'a 'e Vaso'"!a&a'o%es , AINE(
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rogresi,n de la etapa de IRA: $to> ICA6y 4
*( Qu"&a% '"u%&"cos
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#CR es ?2>= mg ;dl
• IRA fase 2 *ue no responden
SCR es *,0 m78'!
AKI es&aca *
AKI es&aca *
Uso &em%ano 'e 3asocons&%"c&o%es• &e%!"%es"na• no%e"ne$%"na• m"'o'%"na !us oc&%eo&"'a
• Toma% so4%e una 4ase caso o% caso,• La e3a!uac"#n 'e !a e&"o!o7a 'e !a IRA• La %esenc"a o ausenc"a 'e $ac&o%es %ec""&an&es•
Fa!!os o%7@n"cos, o con'"c"ones com#%4"'a(
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)or *u+ necesitamos cambiar los critediagn,stico de %R# en el marco de la
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No e%m"&en e! "n"c"o 'e! T&o( – Vasocons&%"c&o%es > A!4=m"na ;as&a SC% J