ICU Cases · AKI & RRT
Hot case — the recovering kidney: assessing the patient on continuous renal replacement therapy
A CICM hot case — a 20-minute live bedside encounter on a patient whose kidneys are recovering on CRRT. Tests the bedside examination of a patient on RRT, the interpretation of circuit and metabolic data, and the decision to de-escalate and cease renal replacement therapy.
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You are taken to the bedside of a 59-year-old woman who is on day 5 of continuous venovenous haemodiafiltration. She was admitted with septic shock from a urinary source, developed oligo-anuric KDIGO stage 3 AKI, and was commenced on CRRT on day 2 for refractory hyperkalaemia and fluid overload. She is now off noradrenaline, her lactate is normal, and she has started producing urine — 40 mL per hour over the last 12 hours, rising.
[2]The examiner asks you to assess her at the bedside and to outline your plan for her renal replacement therapy over the coming days.[3]
[1]References4ShowHide
- [1]Bagshaw SM, Wald R, Adhikari NKJ, et al. Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI). New England Journal of Medicine, 2020.PMID 32668114
- [2]Bellomo R, Cass A, Cole L, et al. Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients (RENAL). New England Journal of Medicine, 2009.PMID 19846848
- [3]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [4]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.