Updating risk prediction tools a case study in prostate cancer

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Investigators have since applied the RIFLE system to the clinical evaluation of AKI, although it was not originally intended for that purpose. The criteria that support the most severe classification should be used.

The superimposition of acute on chronic failure is indicated with the designation RIFLE-F; failure is present in such cases even if the increase in SCreat is less than 3-fold, provided that the new SCreat is greater than 4.0 mg/d L (350 µmol/L) and results from an acute increase of at least 0.5 mg/d L (44 µmol/L).

In addition, diseases exist that commonly present with simultaneous pulmonary and renal involvement, including the following: Hypoxia commonly occurs during hemodialysis and can be particularly significant in the patient with pulmonary disease.

This dialysis-related hypoxia is thought to occur secondary to white blood cell (WBC) lung sequestration and alveolar hypoventilation.

This condition is usually marked by a rise in serum creatinine concentration or by azotemia (a rise in blood urea nitrogen [BUN] concentration).

A rise in the creatinine level can result from medications (eg, cimetidine, trimethoprim) that inhibit the kidney’s tubular secretion, while a rise in the BUN level can also occur without renal injury, resulting instead from such sources as gastrointestinal (GI) or mucosal bleeding, steroid use, or protein loading.

The Acute Kidney Injury Network (AKIN) has developed specific criteria for the diagnosis of AKI.

The AKIN defines AKI as abrupt (within 48 hours) reduction of kidney function, manifested by any 1 of the following Cardiovascular complications (eg, heart failure, myocardial infarction, arrhythmias, cardiac arrest) have been observed in as many as 35% of patients with AKI.

Many authors recommend a trial of intravenous calcium chloride (or gluconate) in all patients with AKI who experience cardiac arrest.

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