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Acute kidney injury risk factors.

A paper from Ethiopia from collaborating nephrologists (through an International Society of Nephrology's Sister Centre Programme established in 2010) based in Cardiff, Wales, and Addis Ababa highlights how easily a patient's quiet slip into renal failure, from which only dialysis-all too frequently unavailable, even in SA-can rescue them, can be overlooked on the wards. [4] It doesn't help that many patients have pre-existing renal dysfunction, linked to hypertension, diabetes or age (>65), and that the blood chemistry, if measured, is normal until 50% of renal function is lost. Medical ward personnel were more aware than those on the obstetric or surgical wards. Drugs such as the angiotensin-converting inhibitors and non-steroidal anti-inflammatory drugs (NSAIDs) often 'set the stage' by preventing adaptive haemodynamic changes in face of dehydration/ blood loss. Aminoglycoside antibiotics are direct renal toxins: in the surgical wards they, in combination with NSAIDs, proved particularly injurious. Key to recognising potential trouble is diligent and complete documentation of past medical history and co-morbidities. It is imperative that a diagnosis of any 'co-morbidity' should prompt renal function testing and regular monitoring, with monitoring mandatory if potentially nephrotoxic drugs are prescribed. Though the risk of developing nephrotoxicity following NSAID use is reportedly low, the extensive prescription of NSAIDs for analgesia, when alternative agents are available, puts many patients at unnecessary risk.

The following bears noting: 'The recent National Confidential Enquiry into Perioperative Deaths (NCEPOD) report on AKI in the UK suggested that 29% of patients did not have adequate assessment or documentation of the most important risk factors for AKI.' As in the Ethiopian study, medication and co-morbidity were among the most common risk factors not assessed!

[4.] Phillips L, Allen N, Phillips B, et al. Acute kidney injury risk factor recognition in three teaching hospitals in Ethiopia. S Afr Med J 2013;103(6):413-418. []

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Title Annotation:EDITOR'S CHOICE
Publication:South African Medical Journal
Article Type:Editorial
Geographic Code:6SOUT
Date:Jun 1, 2013
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