HOMECARE GENTAMICINE TREATMENT FOLLOWED BY SEVERE RENAL INJURY ASOCIATED WITH HIPOALBUMINEMY AND DEHIDRATATION (CLINICAL CASE)

HOMECARE GENTAMICINE TREATMENT FOLLOWED BY SEVERE RENAL INJURY ASOCIATED WITH HIPOALBUMINEMY AND DEHIDRATATION (CLINICAL CASE)

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Title:	HOMECARE GENTAMICINE TREATMENT FOLLOWED BY SEVERE RENAL INJURY ASOCIATED WITH HIPOALBUMINEMY AND DEHIDRATATION (CLINICAL CASE)
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Article_Title:	HOMECARE GENTAMICINE TREATMENT FOLLOWED BY SEVERE RENAL INJURY ASOCIATED WITH HIPOALBUMINEMY AND DEHIDRATATION (CLINICAL CASE)
Authors:	Nicolescu Cristian12, Nicolescu Laura12, Moldovan Silviu1, Gatcan Sergiu1, Stirbu Oana1,2, Damian Gratian1,2, Pop Alexandru2
Affiliation:	1Arad County Hospital 2Western University “Vasile Goldis” Arad
Abstract:	Presenting the case of 83 year old patient A.R., brought to ER for severe dyspnea due to a total left pneumothorax. After mounting the pleural drainage tube, the patient is admiitted into ICU, presenting significantly altered renal probes and showing specific clinical signs of acute dehydration syndrome and systemic uremic syndrome. The patient is given crystalloid and colloid solutions to correct the water deficite and improve renal perfusion, but the clinical condition does not improve, diuresis is absent at the 4 mark, thus it’s decided to establish continuous renal support consisting in continuous veno-venous hemodiafiltration.At the same time the patient is receiving additional therapy with hypertonic solution of 20% albumin to correct severe hypoalbuminemia. Patient evolution is ultimatly favorable under diuretic treatment administered continuously, evaluation of hidric balance on a daily basis and with fluid intake adjustment on the basis of that balance.
Keywords:	tubular necrosis, sepsis, hypoalbuminemia, renal injury severe dehydration
References:	1. Hsu CY, McCulloch CE, Fan D, Ordoñez JD, Chertow GM, Go AS. Community-based incidence of acute renal failure. Kidney Int. 2007;72(2):208–212. 2. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002;39(5):930–936. 3. Hoste EA, Schurgers M. Epidemiology of acute kidney injury: how big is the problem? Crit Care Med. 2008;36(4 suppl):S146–S151. 4. Hoste EA, Clermont G, Kersten A, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care. 2006;10(3):R73. 5. Ympa YP, Sakr Y, Reinhart K, Vincent JL. Has mortality from acute renal failure decreased? A systematic review of the literature. Am J Med. 2005;118(8):827–832. 6. Gruberg L, Weissman NJ, Pichard AD, et al. Impact of renal function on morbidity and mortality after percutaneous aortocoronary saphenous vein graft intervention. Am Heart J. 2003;145(3):529–534. 7. Uchino S, Kellum JA, Bellomo R, Beginning and Ending Supportive Therapy for the Kidney 9. Holley JL. Clinical approach to the diagnosis of acute renal failure. In: Greenberg A, Cheung AK, eds. Primer on Kidney Diseases. 5th ed. Philadelphia, Pa.: National Kidney Foundation; 2009. 10. Kaufman J, Dhakal M, Patel B, Hamburger R. Community-acquired acute renal failure. Am J Kidney Dis. 1991;17(2):191–198. 11. Christensen PK, Hansen HP, Parving HH. Impaired autoregulation of GFR in hypertensive non-insulin dependent diabetic patients. Kidney Int. 1997;52(5):1369–1374. 12. Smith MC. Acute renal failure. In: Resnick MI, Elder JS, Spirnak JP, eds. Clinical Decisions in Urology. 3rd ed. Hamilton, Ontario, Canada: BC Decker, Inc.; 2004:60–63. 13. Clarkson MR, Giblin L, O’Connell FP, et al. Acute interstitial nephritis: clinical features and response to corticosteroid therapy. Nephrol Dial Transplant. 2004;19(11):2778–2783. 14. González E, Gutiérrez E, Galeano C, Grupo Madrileño De Nefritis Intersticiales, et al. Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis. Kidney Int. 2008;73(8):940–946. 15. Meyer TW, Hostetter TH. Uremia. N Engl J Med. 2007;357(13):1316–1325. 16. Agrawal M, Swartz R. Acute renal failure [published correction appears in Am Fam Physician. 2001;63(3):445]. Am Fam Physician. 2000;61(7):2077–2088. 17. Lewington A, Kanagasundaram S. Clinical practice guidelines: acute kidney injury. 2011. http://www.renal.org/clinical/guidelinessection/AcuteKidneyInjury.aspx. Accessed September 7, 2012. 18. O’Neill WC. Sonographic evaluation of renal failure. Am J Kidney Dis. 2000;35(6):1021–
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Article Title:	HOMECARE GENTAMICINE TREATMENT FOLLOWED BY SEVERE RENAL INJURY ASOCIATED WITH HIPOALBUMINEMY AND DEHIDRATATION (CLINICAL CASE)
Authors:	Dr. Nicolescu Cristian12, Dr.Nicolescu Laura12,Dr.Moldovan Silviu1,Dr. Gatcan Sergiu1,Dr.Stirbu Oana1,2, Dr.Pop Alexandru2
Affiliation:	1Arad County Hospital 2Western University “Vasile Goldis” Arad
Abstract:	Presenting the case of 83 year old patient A.R., brought to ER for severe dyspnea due to a total left pneumothorax. After mounting the pleural drainage tube, the patient is admiitted into ICU, presenting significantly altered renal probes and showing specific clinical signs of acute dehydration syndrome and systemic uremic syndrome. The patient is given crystalloid and colloid solutions to correct the water deficite and improve renal perfusion, but the clinical condition does not improve, diuresis is absent at the 4 mark, thus it’s decided to establish continuous renal support consisting in continuous veno-venous hemodiafiltration.At the same time the patient is receiving additional therapy with hypertonic solution of 20% albumin to correct severe hypoalbuminemia. Patient evolution is ultimatly favorable under diuretic treatment administered continuously, evaluation of hidric balance on a daily basis and with fluid intake adjustment on the basis of that balance.
Keywords:	tubular necrosis, sepsis, hypoalbuminemia, renal injury severe dehydration
References:	1. Hsu CY, McCulloch CE, Fan D, Ordoñez JD, Chertow GM, Go AS. Community-based incidence of acute renal failure. Kidney Int. 2007;72(2):208–212. 2. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002;39(5):930–936. 3. Hoste EA, Schurgers M. Epidemiology of acute kidney injury: how big is the problem? Crit Care Med. 2008;36(4 suppl):S146–S151. 4. Hoste EA, Clermont G, Kersten A, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care. 2006;10(3):R73. 5. Ympa YP, Sakr Y, Reinhart K, Vincent JL. Has mortality from acute renal failure decreased? A systematic review of the literature. Am J Med. 2005;118(8):827–832. 6. Gruberg L, Weissman NJ, Pichard AD, et al. Impact of renal function on morbidity and mortality after percutaneous aortocoronary saphenous vein graft intervention. Am Heart J. 2003;145(3):529–534. 7. Uchino S, Kellum JA, Bellomo R, Beginning and Ending Supportive Therapy for the Kidney 9. Holley JL. Clinical approach to the diagnosis of acute renal failure. In: Greenberg A, Cheung AK, eds. Primer on Kidney Diseases. 5th ed. Philadelphia, Pa.: National Kidney Foundation; 2009. 10. Kaufman J, Dhakal M, Patel B, Hamburger R. Community-acquired acute renal failure. Am J Kidney Dis. 1991;17(2):191–198. 11. Christensen PK, Hansen HP, Parving HH. Impaired autoregulation of GFR in hypertensive non-insulin dependent diabetic patients. Kidney Int. 1997;52(5):1369–1374. 12. Smith MC. Acute renal failure. In: Resnick MI, Elder JS, Spirnak JP, eds. Clinical Decisions in Urology. 3rd ed. Hamilton, Ontario, Canada: BC Decker, Inc.; 2004:60–63. 13. Clarkson MR, Giblin L, O’Connell FP, et al. Acute interstitial nephritis: clinical features and response to corticosteroid therapy. Nephrol Dial Transplant. 2004;19(11):2778–2783. 14. González E, Gutiérrez E, Galeano C, Grupo Madrileño De Nefritis Intersticiales, et al. Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis. Kidney Int. 2008;73(8):940–946. 15. Meyer TW, Hostetter TH. Uremia. N Engl J Med. 2007;357(13):1316–1325. 16. Agrawal M, Swartz R. Acute renal failure [published correction appears in Am Fam Physician. 2001;63(3):445]. Am Fam Physician. 2000;61(7):2077–2088. 17. Lewington A, Kanagasundaram S. Clinical practice guidelines: acute kidney injury. 2011. http://www.renal.org/clinical/guidelinessection/AcuteKidneyInjury.aspx. Accessed September 7, 2012. 18. O’Neill WC. Sonographic evaluation of renal failure. Am J Kidney Dis. 2000;35(6):1021–
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