RENAL FAILURE – THE FACTS Edited by Momir Polenakovic Renal Failure – The Facts Edited by Momir Polenakovic Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Maja Bozicevic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published May, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Renal Failure – The Facts, Edited by Momir Polenakovic p. cm. ISBN 978-953-51-0630-2 Contents Preface IX Chapter 1 Risk Factors for Renal Failure: From Infancy to Adulthood 1 Silvio Maringhini, Vitalba Azzolina, Rosa Cusumano and Ciro Corrado Chapter 2 The Pathogenesis of Acute Kidney Injury 17 Nicholas A. Barrett and Marlies Ostermann Chapter 3 Oxidative and Nitrosative Stress in the Ischemic Acute Renal Failure 25 Miguel G. Salom, B. Bonacasa, F. Rodríguez and F. J. Fenoy Chapter 4 Immunological and Molecular Mechanisms Leading to Fibrosis: Origin of Renal Myofibroblasts 47 Leonóra Himer, Erna Sziksz, Tivadar Tulassay and Ádám Vannay Chapter 5 Effects of Maternal Renal Dysfunction on Fetal Development 81 Toshiya Okada, Yoko Kitano-Amahori, Masaki Mino, Tomohiro Kondo, Ai Takeshita and Ken-Takeshi Kusakabe Chapter 6 Proteomic Biomarkers for the Early Detection of Acute Kidney Injury 105 Stefan Herget-Rosenthal, Jochen Metzger, Amaya Albalat, Vasiliki Bitsika and Harald Mischak Chapter 7 Sepsis and Dialysis Disequilibrium Syndrome 123 Nissar Shaikh Chapter 8 Acute Kidney Injury Following Cardiac Surgery: Prevention, Diagnosis, and Management 129 Emmanuel Moss and Yoan Lamarche VI Contents Chapter 9 Acute Kidney Injury Induced by Snake and Arthropod Venoms 157 Markus Berger, Maria Aparecida Ribeiro Vieira and Jorge Almeida Guimarães Chapter 10 Contrast Nephropathy: A Paradigm for Cardiorenal Interactions in Clinical Practice 187 Michele Meschi, Simona Detrenis, Laura Bianchi and Alberto Caiazza Chapter 11 The Outcome of HIV-Positive Patients Admitted to Intensive Care Units with Acute Kidney Injury 197 J. D. Nel and M. R. Moosa Chapter 12 Management of Heparin-Induced Thrombocytopenia in Uremic Patients with Hemodialysis 203 Takefumi Matsuo Chapter 13 The Psychological Impact of Hemodialysis on Patients with Chronic Renal Failure 217 Liang-Jen Wang and Chih-Ken Chen Chapter 14 Renal Replacement Therapy in Uremic Diabetic Patients – Experience from The Republic of Macedonia 237 Momir H. Polenakovic Preface The book Renal Failure – The Facts consists of some facts about diagnosis, etiopathogenis and treatment of acute and chronic renal failure. Acute, as well as chronic renal failure is great medical problems and their treatment is a burden for the budget of each government. Acute kidney injury (AKI), previously termed acute renal failure, is a frequent clinical condition in critically ill patients especially, in intensive care units (ICU). Its incidence varies from 1-7 % of all hospitalized patients to 30-50 % of patients in ICU. Irrespective of the progress being made in the understanding of the pathophysiology of AKI and its underlying processes and the advances in critical care medicine, mortality rate associated with AKI remains high especially in ICU patients at more than 50 %. In addition, a significant proportion of surviving patients (20 %) develops CKD and end-stage renal disease, requiring chronic renal replacement therapy. Long-term outcome is worse for patients after recovery from AKI, further impacting health care cost and quality of life. In developing countries, AKI is more common in young and pediatric patients, while in developed countries elderly patients are predominant. In critically ill patients the most common cause of AKI is sepsis, accounting for 50 % of all cases. Chronic kidney disease (CKD) is a long-term condition which can arise from the damage to the kidneys from a variety of diseases. Patients with CKD are frequently asymptomatic until the disease is advanced. In 2002 the K/DOQI Clinical Practice Guidelines provided a definition of CKD which is now widely used around the world. Generally, cross-sectional population studies in a number of countries suggests an overall prevalence of CKD 1-5 of >10%. CKD appears to be an independent and significant risk factor for progressive cardio vascular disease (CVD). CVD accounts for ≈ 50% of the death in patients with CKD. The purpose of the chapters is to present some important issues of diagnosis and causes of AKI, as well as caused by snakes and arthropods, after cardiac surgery, as well as some therapeutic achievements in AKI. Well presented are the psychological condition in patients on haemodialysis, as well as the treatment of diabetic uremics. X Preface The book is aimed at clinicians with a special interest in nephrology (including consultants and specialist trainees in nephrology), but it should also prove to be a valuable resource for any generalists who encounter a nephrological problems in their day-to-day practice. Momir H. Polenakovic Macedonian Academy of Sciences and Arts Republic of Macedonia [...]... modifiable, particularly in children, and therapeutic interventions may result in a reduced 6 Renal Failure – The Facts rate of deterioration of renal function The persistent deterioration of renal function may be a result of repeated and chronic insults to the renal parenchyma leading to permanent damage and/or to the adaptive hyperfiltration response of the kidney The reduced glomerular filtration area... long-term morbidity and mortality 2 Renal physiology 2.1 Renal blood supply and oxygenation The chief function of the kidneys (ie filtration of plasma and formation of urine) dictates the renal flow to be much higher than necessary to meet the metabolic needs The kidneys receive blood via the renal arteries which supply them with approximately 25% of cardiac output The vascular supply of nephrons consists... Asystematic review of the literature J Hypertens 18:81 5–8 31, 2000 [30] Hoy WE, Rees M, Kile E, Mathews JD, Wang Z A new dimension to the Barker hypothesis: low birthweight and susceptibility to renal disease Kidney Int 56:107 2– 1077 1999 [31] Lackland DT, Bendall HE, Osmond C, Egan BM, Barker DJ Low birth weights contribute to high rates of early-onset chronic renal failure in the Southeastern United States... into the peritubular arteries and vasa recta Oxygen tensions in the kidney are low, decreasing from 70 mmHg in the cortex to 20 mmHg in the medulla The unique microvasculature of the kidneys coupled with high oxygen demand from the tubular salt-water reabsorption make the kidneys, in particular the medulla highly sensitive to hypoxia (Brezis & Rosen, 1995; Evans, et al., 2008) As a result, the renal. .. 2008) As a result, the renal microcirculation is recognised as a key actor in the initiation and development of AKI 18 Renal Failure – The Facts Basal renal oxygen consumption is approximately 400mmol/min/100g Due to the high renal blood flow, there is a low oxygen extraction (Valtin & Schafer, 1995) Energy dependent processes in the kidney are those related to basal cellular metabolism and those related... end-stage renal disease (ESRD) [48] The increased blood pressure associated with obesity is accompanied by impaired pressure natriuresis Risk Factors for Renal Failure: From Infancy to Adulthood 5 The volume expansion is related to activation of the sympathetic nervous system and reninangiotensin system Obesity also causes renal vasodilation and glomerular hyperfiltration as compensatory mechanisms In the. .. [30] In the last years many studies have documented that low birth weights contribute to high rates of early-onset chronic renal failure in United States patients, in 4 Renal Failure – The Facts ducth adolescents, and in young and adult Norwegians [31-34] In a meta-analysis, White et al found that the combined odds ratio (OR) for risk of albuminuria associated with low birth weight was 1.81 (1.1 9–2 .77)... diagnostic agents (eg, radiographic contrast materials), and others (eg, aminoglycosides, amphotericin B, cyclosporine, and tacrolimus) The administration of such drugs, therefore, should be avoided or used with caution in patients with underlying CKD, with the assistance of therapeutic drug level monitoring [72] 10 Renal Failure – The Facts 6.1 CKD complications Major Problems in children with CKD... considering the institution of rHuGH [79] 6.1.8 Renal replacement therapy Once the estimated GFR declines to less than 30 mL/min per 1.73 m2 (stage 4 CKD), it is time to start preparing the child and the family for renal replacement therapy The family should be provided with information related to preemptive kidney transplantation, peritoneal dialysis, and hemodialysis As in adults, some form of renal replacement... of the models adequately account for the resuscitation and supportive management seen in critically ill patients, making data difficult to extrapolate (Heyman, et al., 2002) 4.2 Haemodynamic changes Experimental evidence for renal haemodynamic changes due to sepsis is inconsistent Animal models variably demonstrate that with preserved systemic blood pressures there is 20 Renal Failure – The Facts either . RENAL FAILURE – THE FACTS Edited by Momir Polenakovic Renal Failure – The Facts Edited by Momir Polenakovic Published by. Diabetic Patients – Experience from The Republic of Macedonia 237 Momir H. Polenakovic Preface The book Renal Failure – The Facts consists