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Ronco C.,International Renal Research Institute of Vicenza IRRIV | Ricci Z.,Pediatric Cardiac Intensive Care Unit | Goldstein S.L.,University of Cincinnati
American Journal of Kidney Diseases | Year: 2015

The application of continuous renal replacement therapy (CRRT) in children, before roller pumps and dialysis monitors were available in the intensive care unit, was realized by continuous arteriovenous hemofiltration. Then hemofiltration was coupled with dialysis in order to increase dialytic dose and system efficiency, and the circuit and filters were specifically modified to optimize patency and session life span. After about 30 years, another revolution is ongoing, in that pediatric acute kidney injury (AKI) and fluid accumulation (for which critically ill newborns and children with multiple-organ dysfunction are greatly at risk) are recognized as independently associated with mortality and identified as primary conditions to prevent and aggressively treat. Today, novel technology specifically dedicated for very young patients will allow feasible and straightfoward application of CRRT to infants and children. This article discusses the authors' personal perspectives on how clinical and technical issues of dialysis in children have been addressed and how today, severe pediatric AKI can be managed with accurate and safe CRRT machines that will likely yield outcome improvements in the coming decades. © 2015 National Kidney Foundation, Inc. Source


Ricci Z.,Pediatric Cardiac Intensive Care Unit | Ronco C.,International Renal Research Institute
Swiss Medical Weekly | Year: 2012

The term acute kidney injury (AKI) has been recently coined by a large panel of international experts in place of the former expression "acute renal failure". This change has been motivated by a double intention: first it served to definitely find a conventional definition for acute changes of renal function, previously lacking in the medical community. In fact, any attempt to compare scientific papers and different centres experiences on AKI was essentially impossible. The second aim was to remark that this syndrome is characterised by a spectrum of progressive damage, from mild creatinine increase to renal injury to a more severe form, failure: this important concept should increase clinicians awareness to every form of renal dysfunction, even milder ones, in order to improve epidemiologic analyses, potentially preventing eventual AKI progression and finally helping standardisation of medical and supportive therapy. This review will describe such "new era" of critical care nephrology by presenting current literature (and its many controversies) about AKI diagnosis, physiopathology and management. Source


Ronco C.,Dialysis and Transplantation | Ronco C.,International Renal Research Institute | Ricci Z.,Pediatric Cardiac Intensive Care Unit
Intensive Care Medicine | Year: 2015

Introduction: More than 20 years have passed since the first clinical application of continuous renal replacement therapy (CRRT) in children. In that revolutionary era, before roller pumps and dialysis monitors for intensive care units were readily available, continuous arteriovenous hemofiltration was the most common treatment for critically ill children. Major findings: Those steps were the basis for current knowledge about modern CRRT. Research on circuit rheology and filter materials allowed for the improvement of materials, and the optimization of patency and session life spans. Hemofiltration was coupled with dialysis to increase dialytic dose and system efficiency. Several systems were required to optimize ultrafiltration and manage fluid overload. A quarter of a century later, another revolution is taking place. Acute renal failure has been recognized as a threatening syndrome, independently associated with mortality in critically ill children and characterized by a broad spectrum of clinical phenotypes. For this reason, it has been redefined as acute kidney injury (AKI). This condition is today accurately classified in both adults and children, and has been identified as a primary condition for prevention and aggressive treatment in all pediatric intensive care unit patients. Critically ill neonates and children with multiple organ dysfunction are certainly at higher risk of AKI. Finally, novel technology specifically dedicated to pediatric patients allows feasible and easy application of CRRT to infants and children: a new field of critical care nephrology, dedicated to pediatric patients, has been fully developed. Conclusion: After 20 years, significant developments in critical care nephrology have taken place. Clinical and technical issues have both been addressed, and severe pediatric AKI can currently be managed with accurate and safe dialysis machines that will likely warrant outcome improvements over the following decade. © 2015, Springer-Verlag Berlin Heidelberg and ESICM. Source


Ricci Z.,Pediatric Cardiac Intensive Care Unit
Trends in Anaesthesia and Critical Care | Year: 2013

This review will describe the "new era" of critical care nephrology by presenting the current literature (and its many controversies) concerning the diagnosis, physiopathology and management of acute kidney injury (AKI). A conventional definition for the acute changes of renal function, previously lacking in the medical community, has recently been proposed in order to gather and compare the experiences of different centres relating to AKI incidence and management. Such a new definition is actually a classification that describes renal damage as a spectrum of progressive damage, from mild creatinine increase to renal injury and through to a more severe form, failure: preventive measures, medical treatment and dialysis can now be standardized and data collected in order to improve the outcome of critically ill patients with AKI. © 2012 Elsevier Ltd. Source


Ricci Z.,Pediatric Cardiac Intensive Care Unit | Ronco C.,International Renal Research Institute
Current Opinion in Critical Care | Year: 2012

PURPOSE OF REVIEW: Survival of critically ill patients with severe acute kidney injury is still low. The aim of this review is to describe recent scientific evidence on renal replacement therapy (RRT) and its potential implications for future research and clinical practice. RECENT FINDINGS: Timing, dose and special indications of RRT will be described: recent literature provided new answers and new controversies about these three topics. SUMMARY: Specific research on RRT timing will be mandatory in the next few years: a standard definition of timing will certainly help to shed new light on how to improve RRT patients' outcome. Dialytic dose of continuous RRT has been recently and definitely standardized to 20-25ml/kg per hour (dialysis or hemofiltration), however, application to clinical practice still needs to be improved and new evidence on net ultrafiltration prescription showed that fluid balance may be as important as blood purification in critically ill patients with renal dysfunction. Special settings such as septic RRT, pediatric RRT, and RRT during extracorporeal membrane oxygenation recently achieved important results and new applications in clinical practice with important consequences for technical improvement and future care of these patients. Copyright © 2012 Lippincott Williams & Wilkins. Source

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