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Critical Care Nephrology
Critical Care Nephrology
Claudio Ronco Department of Nephrology SI. Bortolo Hospital Vicenza, /faly
and
Rinaldo Bellomo Department of Intensive Gare Austin and Repatriation Hospital Melboume, Australia
.... " Springer-Science+Business Media, B.V.
Library of Congress Cataloging-in-Publication Data
Critical care nephrology I edited by Claudio Ronco and Rinaldo Bellorno.
p. CN.
1ncludes Index.
1. Renal Intensive care. 1. Roneo, C. (Claudlo), 1951-11. Bello.o, R. (Rlnaldo), 1955-
[ONLM: 1, Kldney 0Iseases--therapy. 2. Kldney Dlseases-compllcatlons. 3. Intensive Care. WJ 300 C934 1997] RC903.C75 1997 S1S.S'1028--dc21 ONLM/DLC for Library of Congress 97-17215
03-1099-200 ts
Printed on acid-free paper
All Rights Reserved © 1998 Springer Science+Business Media Dordrecht Originally published by Kluwer Academic Publishers in 1998
No part of the material protected by this copyright notice may be reproduced or utilized in any form or by any means, electronic or mechanicaI, including photocopying, recording or by any information storage and retrieval system, without written permission from the copyright owner.
ISBN 978-94-010-6306-7 ISBN 978-94-011-5482-6 (eBook)DOI 10.1007/978-94-011-5482-6
To Paola and Federico and to Debrah and Hilary for their patient and loving support during this endeavour,
and for filling our lives and work with meaning.
Table of Contents
Foreword: The Nephrology Side Robert W. Schrier
Foreword: The Intensive Care Side Ake Grenvik
Preface Claudio Ronco and Rinaldo Bellomo
List of Contributors
Section 1: The Critically III Patient Section Editor: Michael R. Pinsky
1. Applied cardiovascular physiology Michael R. Pinsky
2. Fundamentals of resuscitation John J. Brady and Michael R. Pinsky
3. Prediction of outcome in critically ill patients Gilles Clermont and Derek C. Angus
4. Rationale and application of physiologic monitoring Michael R. Pinsky
5. Pharmacologic support of the hemodynamically unstable patient Navdeep K. Mehta and Michael R. Pinsky
Section 2: Elements of Basic Sciences Section Editors: Claudio Ronco and Hans Joachim Weber
xvii
xix
xxi
xxiii
9
19
33
43
1. Fu.ndamentals of applied probability and basic statistics 51 Gerhard Dikta
2. Applied physics of compressible and incompressible fluids 63 Hans Joachim Weber
3. Elements of applied immunology for the intensive care unil amI chronic uremia-related disorders ~5
Beatrice Descamps-Latscha and Paul Jungers
viii TABLE OF CONTENTS
4. Basic elements of applied microbiology in the intensive care unit Stephen I. Vas
5. Basic elements of applied pharmacology in the intensive care unit Michael F. Flessner
6. Fundamentals of biochemistry and energy metabolism in the normal subject and in the critically ill patient Xavier M. Leverve and Noel Cano
Section 3: Epidemiology of Kidney Diseases in the Intensive Care Unit Section Editor: David Bihari
1. Epidemiology of acute renal failure in the intensive care unit Ian C. Abbs and J. Stewart Cameron
2. Risk factors for acute renal failure in critically ill patients Dieter Kleinknecht
3. Assessment of outcome from acute renal failure Kathleen Daly and David Bihari
Section 4: Fluid and Electrolyte Problems in the Intensive Care Unit and Acute Renal Failure Section Editors: Francesco Locatelli and Lambert G. Thijs
1. Regulatory mechanisms of fluid and electrolyte turnover Reinold O. B. Gans and Pieter M. ter Wee
2. Edematous states in the intensive care unit Walther H. Boer and Hein A. Koomans
3. Hypernatremia and hyponatremia Lambert G. Thijs
4. Hyper- and hypokalemia in critical patients Bruno Redaelli and Giovanna Bonoldi
5. Calcium phosphate and magnesium balance in patients with acute illness Giuseppe Pontoriero, Francesco Locatelli and Eberhard Ritz
6. Trace metals in patients with acute renal failure Patrick C. D'Haese and Marc E. De Broe
7. Fluid and electrolyte balance during peritoneal dialysis Raymond T. Krediet
8. Fluid and electrolyte balance during extracorporeal therapies Francesco Locatelli, Salvatore Di Filippo and Giuseppe Pontoriero
Section 5: Acid-base Problems in the Critically III Section Editors: Mariano Feriani and John A. Kellum
1. Biochemical and biophysical principles of hydrogen ion regulation Martine Leblanc and John A. Kellum
103
111
125
133
143
153
163
175
183
197
211
225
231
249
261
TABLE OF CONTENTS ix
2. Pathophysiology of metabolic acid-base disturbances in patients with critical illness 279 Sheldon Magder
3. Pathophysiology and diagnosis of respiratory acid-base disturbances in patients with critical illness 297 Luciano Gattinoni and Alfredo Lissoni
4. Impact of acid-base disorders on individual organ systems 313 David M. Forrest, Keith R. Walley and James A. Russell
5. Correction of acid-base derangements 327 Aaron Spital and Serafino Garella
6. Acid-base balance during renal replacement therapies 345 Mariano Feriani
Section 6: Metabolism in the Critically III Patient with and without Acute Renal Failure Section Editors: Jonas Bergstrom and Gaetano Iapichino
I. Carbohydrate, lipid and protein metabolism in the critically ill patient Peter Furst
2. Nutritional management of the critically ill patient with and without renal failure Peter Barany and Anders Alvestrand
3. Hormonal status in critically ill patients with or without acute renal failure Peter Stenvinkel
4. Enteral and parenteral nutrition in patients undergoing continuous renal replacement therapies Gaetano Iapichino, Danilo Radrizzani and Andrea Nota
Section 7: Infections in Intensive Care Patients Section Editors: Fausto de Lalla and Peter Linden
1. Microbiological considerations in intensive care Silvana Esposito
2. Upper and lower respiratory tract infection Peter Linden
3. Urinary tract infections Martine Leblanc
4. Intestinal and peritoneal infections Mario Cruciani, Marina Malena and Fausto de Lalla
5. Skin and soft tissue infections Mario Cruciani and Fausto de Lalla
6. Intravascular catheter infections in the intensive care unit Giampietro Pellizzer and Fausto de Lalla
7. Antibiotics in intensive care patients Fausto de Lalla and Mario Cruciani
355
375
391
405
413
421
441
455
461
469
479
x TABLE OF CONTENTS
Section 8: The Kidney in Sepsis Section Editors: Giuseppe Remuzzi and lean-Louis Vincent
1. Pathophysiology of the sepsis syndrome 495 lean-Louis Vincent
2. Influence of cytokines on the renal circulation and nephron function 503 Jeffrey R. Schelling and John R. Sedor
3. Renal alterations in the septic patient 517 Jane Goddard and Allan D. Cumming
4. Endothelial dysfunction in acute renal failure 527 Anupam Agarwal and Leopoldo Raij
5. Role of eicosanoids in sepsis-induced acute renal failure 551 Bertrand Guidet and Laurent Baud
6. The role of oxygen free radicals in acute renal failure 557 Mark S. Paller
7. Nitric oxide as a mediator of hemodynamic disturbances in acute renal failure associated with sepsis 557 Marina Noris
Section 9: Acute Renal Failure 1 Section Editors: Andrew Bersten and Giovanni Camussi
1. Acute renal failure-definitions and diagnosis Allan D. Cumming
2. Hemodynamic factors influencing renal blood flow Andrew D. Bersten and Andrew W Holt
3. Tubuloglomerular feedback and its role in acute renal failure Hartmut Osswald and Volker Vallon
4. The histopathology of acute renal failure Lorraine C. Racusen
5. The immune system and the kidney Luigi Biancone, Donato Donati, Luigi Gastaldi and Giovanni Camussi
6. Vasculitis, glomerulonephritis and acute renal failure ludy Savige
Section 10: Acute Renal Failure 2 Section Editors: Vittorio Emanuele Andreucci and Eberhard Ritz
1. Drug-induced acute renal failure Giuseppe Conte, Vicenzo Bellizzi, Luca De Nicola and Vittorio Emanuele Andreucci
591
599
613
623
631
651
669
TABLE OF CONTENTS
2. Post-surgery I Poly trauma and acute renal failure Adrian Iaina and Gari Peer
3. Fluid and electrolyte disorders and renal function impairment after bums Vittorio Emanuele Andreucci, Giorgio Fuiano and Michele Andreucci
4. Acute obstructive nephropathy Saulo Klahr
5. Acute renal failure in pregnancy and postpartum Jacques Bernheim and Eduardo Podjarny
6. Hantavirus-induced acute renal failure Martin Zeier, Lothar Zoller and Eberhard Ritz
7. Rhabdomyolysis Aldo Fabris, Maria Valentina Pellanda and Claudio Gardin
8. Acute renal dysfunction after renal transplantation Martin Zeier, Stephan R. Orth and Eberhard Ritz
9. Acute renal failure in human immunodeficiency virus disease T. K. Sreepada Rao and Eli A. Friedman
Section 11: Acute Renal Failure 3 Section Editor: Allen R. Nissenson
xi
683
693
705
713
729
739
749
761
1. Clinical features of acute renal failure syndrome 773 James Y. Shin and Robert E. Cronin
2. Bleeding and hemostatic defects in uremia 783 Geoffrey A. Block and Richard D. Swartz
3. Gastrointestinal problems in acute renal failure 793 May T. Chow, Vasant C. Gandhi, Todd S. Ing and David J. Leehey
4. Cardiovascular problems in acute renal failure 803 Edwin A. Rutsky and Stephen G. Rostand
5. Acute renal failure as part of the multiple organ failure syndrome (MOF) 807 Andre A. Kaplan
6. Acute renal failure in children and newborns: pathophysiology, clinical patterns and therapeutic approach 821 Charles I. Stewart, Frederick 1. Kaskel and Richard N. Fine
7. Metabolic perturbations in patients with acute renal failure 831 Wilfred Druml
8. Neurological problems in acute renal failure 839 Cosmo L. Fraser and Allen I. Arieff
XlI
Section 12: Uremic Toxins Section Editors: Walter HorZ and Raymond Vanholder
1. Pathogenesis of uremic toxicity Raymond Vanholder
2. Low molecular weight uremic toxins Raymond Vanholder
3. High molecular weight uremic toxins Walter H. HorZ
4. AGE-modified proteins in renal failure Marianne Haag-Weber
Section 13: Acute Intoxication and Poisoning Section Editors: James F. Winchester and Angelo M. Taveira-Da Silva
1. Principles of management of the poisoned patient Angelo M. Taveira-Da Silva
2. Antidotes for acute poisoning and intoxication Charles A. Read
3. Drug intoxication: manifestations and treatment Sayeed Qazi and James F. Winchester
Section 14: The Liver and the Kidney Section Editor: John A. Kellum
1. Liver-kidney interaction Edmund Bourke
2. The kidney in liver disease Vicente Arroyo, Pau Sort and Pere Gines
3. The liver in kidney disease John 1. Brady and John A. Kellum
4. The kidney in liver transplantation John P. Johnson and Paul M. Palevsky
5. Extracorporeal liver support and the kidney Norman L. Sussman and James H. Kelly
Section 15: The Heart and the Kidney Section Editors: Didier Journois and Volker Wizemann
1. Cardiovascular system in renal failure: cardiac complications in renal failure Volker Wizemann
2. Arterial function in renal failure Gerard M. London
TABLE OF CONTENTS
845
855
869
877
885
897
907
919
927
941
949
959
969
975
TABLE OF CONTENTS
3. The kidney in cardiac failure: today's perspective Peter Gross, Martin Schadt, Jens Passauer, Dierk Werner, Eckhart Bussemaker
4. Hypertensive emergencies Karel M. L. Leunissen and Jeroen P. Kooman
5. Prophylaxis of acute renal failure before and during open heart surgery Hilary P. Grocott and Robert N. Sladen
Section 16: The Lung and the Kidney Section Editor: Hilmar Burchardi
1. Pulmonary edema and other disorders in acute renal failure Kenneth W Presberg and Richard M. Effros
2. Acute renal failure in acute respiratory distress syndrome Daniel P. Schuster and David Windus
3. Effects of mechanical ventilation on kidney function Hilmar Burchardi
4. The kidney: a target organ during mechanical ventilation Martin O. Krebs and Gabriele Kaczmarczyk
5. Kidney function during extracorporeal lung assist techniques (ECMO/ECC02R) Mark J. Heulitt and James Marshall
Section 17: The Brain and the Kidney Section Editor: Alex M. Davison
1. Neurological disorders in patients with acute renal failure Andrew Davenport
2. Brain death and organ donation J. Peter A. Lodge and Mark C. Bellamy
Section 18: Supportive Renal Therapy in the Critically III Patient Section Editors: Rinaldo Bellomo and Claudio Ronco
Xlll
983
1003
1021
1037
1047
1055
1067
1073
1081
1105
1. Supportive management strategies in chronic or end stage renal failure patients with critical illness 1125 Paul M. Palevsky
2. The use of inotropic and vasopressor agents in patients at risk of renal dysfunction 1133 Rinaldo Bellomo and Claudio Ronco
3. Renal replacement therapy in patients with chronic (end stage) renal failure and acute illness 1139 Miet Schetz
4. Pharmacologic therapy in acute renal failure: the role of diuretics 1155 John A. Kellum and Abdul K. Garuba
XIV
Section 19: Continuous Renal Replacement Therapy (CRRT) Section Editors: Rinaldo Bellomo and Claudio Ronco
TABLE OF CONTENTS
1. History and development of continuous renal replacement therapy (CRRT) 1161 Heinz-Gunther Sieberth
2. Nomenclature for continuous renal replacement therapies 1169 Claudio Ronco and Rinaldo Bellomo
3. Vascular access for continuous renal replacement therapy 1177 Vanita Jassal and Andreas Pierratos
4. The extra-corporeal circuit: physical principles and monitoring 1189 Randall D. Jenkins
5. Anticoagulation for continuous renal replacement therapies 1199 Ravindra L. Mehta
6. Principles of solute clearance during continuous renal replacement therapy 1213 Claudio Ronco and Rinaldo Bellomo
7. Continuous versus intermittent renal replacement therapy in the critically ill 1225 William Silvester, Rinaldo Bellomo and Claudio Ronco
8. Removal and generation of inflammatory mediators during continuous renal replacement therapies 1239 Ciro Tetta, Filippo Mariano, Claudio Ronco and Rinaldo Bellomo
9. Removal of drugs, toxins and poisons by continuous hemofiltration 1249 Thomas A. Golper and Michael A. Marx
10. Non-renal indications of continuous renal replacement therapies 1259 Didier Journois and Eric Playe
11. Current technology for continuous renal replacement therapies 1269 Claudio Ronco, Alessandra Brendolan and Rinaldo Bellomo
12. Nursing issues, practices and perspectives for the management of continuous renal replacement therapy in the intensive care unit 1309 Ian C. Baldwin, Nicholas P. Bridge and Tania D. Elderkin
13. Guidelines for drug dosing during continuous renal replacement therapies 1327 Jonathan N. Buckmaster and Andrew R. Davies
14. Acute renal failure in infancy: treatment by continuous renal replacement therapy 1335 Claudio Ronco and Rinaldo Bellomo
15. Complications of continuous renal replacement therapies 1351 Claudio Ronco and Rinaldo Bellomo
Section 20: Peritoneal Dialysis in the Intensive Care Unit Section Editors: Giuseppe La Greca and Ram Gokal
1. Principles of peritoneal dialysis and its application in acute renal failure Norbert Lameire
1357
XVI TABLE OF CONTENTS
4. Prevention, amelioration and conservative therapy of acute renal failure in the elderly Haskel Eliahou, Norbert Lameire, Raymond Vanholder and Eric Hoste
Index
1565
1577
TABLE OF CONTENTS
2. Indications, contraindications and complications of peritoneal dialysis in the critically ill Sharad Goel, Rajiv Saran and Karl D. Nolph
Section 21: Intermittent Hemodialysis in the Intensive Care Unit Section Editors: Juan P. Bosch and Bernard Canaud
xv
1373
1. Rationale for intermittent renal replacement therapy (IRRT) in acute renal failure (ARF) 1383 Bernard Canaud, Helene Leray-Moragues, Laurie Garred, Martine Leblanc and Charles Mion
2. Biophysics of intermittent renal replacement therapy 1391 Laurie Garred, Bernard Canaud and Jean-Yves Bosc
3. Intermittent renal replacement modalities and indications 1411 Bernard Canaud, Martine Leblanc, Laurie Garred, Charles Mion and Juan P. Bosch
4. Vascular access for intermittent renal replacement therapy 1421 Helene Leray-Moragues, Martine Leblanc and Bernard Canaud
5. Antithrombotic management of the blood circuit in intermittent renal replacement therapy 1427 Philippe Moriniere, Bertrand deCagny, Najeh El Esper, Jean M. Achard, Pierre F. Westeel and Albert Fournier
6. Risks and hazards of intermittent renal replacement therapy 1441 Kada Klouche and Jean J. Beraud
7. Drug administration in intermittent renal replacement therapy 1457 Miet Schetz
8. Nutritional requirements in critically ill patients treated with intermittent renal replacement therapy 1473 Kada Klouche and Jean J. Beraud
Section 22: Imaging of the Kidney and Urinary Tract in Acute Renal Failure Section Editor: Zoltan H. Endre
1. Imaging of the kidney in the critically ill Guglielmo Fodor and Bruno Giacon
2. Radionuclide scanning in critical care nephrology Joseph C. H. Wong
3. Magnetic resonance imaging and spectroscopy in critical care nephrology Zoltdn H. Endre
Section 23: Special Problems in the Intensive Care Unit Section Editor: Haskel Eliahou
1. Acute renal failure scoring Fernando Liano, Kim Solez, Haskel Eliahou and Dieter Kleinknecht
2. Acute illness superimposed on chronic renal failure Eric Hoste, Norbert Lameire and Raymond Vanholder
3. The diabetic with acute renal failure in the intensive care unit Pesach Segal and Haskel Eliahou
1491
1503
1517
1535
1547
1559
Foreword: The Intensive Care Side
Critical Care Medicine is no longer a young specialty in medicine. Essentially, it was introduced in the 1950s with respiratory care and mechanical ventilation during the worldwide polio epidemics. Anesthesiologists were first involved both in Europe and in the United States through the 1960s and 70s, because of airway problems, use of ventilators and cardiopulmonary resuscitation, all activities familiar to the anesthesiologist from the operating room.
During the 1980s internists and pediatricians increasingly became interested and heavily involved in intensive care, especially in the United States. This interest was later shared by surgeons who, particularly in the 1990s, have become common critical care specialists in the lCU setting.
Gradually, pulmonologists, cardiologists, neurologists, neurosurgeons, cardiothoracic surgeons, traumatologists and transplant surgeons have demonstrated particular interest in the management of their patients in the lCU. Nephrologists are not yet common amongst critical care specialists but most critically ill and injured patients, with time, develop renal failure. Nephrologists are then called upon as consultants to deal with specific renal problems, especially when dialysis becomes necessary, which is common in intensive care.
Respiratory intensive care, critical care cardiology and pediatric critical care, medical and surgical critical care have all been addressed in a number of different textbooks, some of them currently in preparation of a fourth edition, which indicates that the subspecialty of CCM is coming of age. Throughout these years, however, there has not been a good quality and extensive book on the specific problems related to renal disease in critical illness. It is against this background, that Drs Ronco and Bellomo decided to gather a number of renowned ICU physicians, surgeons, and nephrologists with special interest in critical care, and patients with multiple organ failure, practically always including the kidneys, to produce a comprehensive text written especially for intensivists and nephrologists dealing with these patients.
This critical care nephrology text provides thorough
background information on those critically ill patients, who commonly develop renal disease for a complete understanding of the underlying disease mechanisms, pathophysiology and of how best to diagnose and manage renal failure in these patients. The editors have succeeded in providing a most useful book which, in detail, discusses the underlying problems and the appropriate use of renal replacement therapy in the presence of very complex situations, varying from trauma and cardiorespiratory failure to transplantation of different organs, not only the kidney itself, and use of artificial organs. Infections are common in all critically ill patients and this also is dealt with in admirable detail. Pre-renal, renal and post-renal kidney failure patients all receive detailed discussion, as well as the pros and cons of potentially nephrotoxic drugs, such as antibiotics and immunosuppressive drugs.
It should be clear from the above description that this book is a welcome addition to the critical care literature. While it may primarily be directed to intensivists and nephrologists with interest in the critically ill patient, many others will find this book an excellent source of references, which should find its way to each ICU in the world. Increasingly, knowledgeable ICU nurses may also wish to learn more about their problem patients. Thus, it is anticipated that this book will be most appreciated as an important contribution to existing broader textbooks on critical care at large. None of these deal with renal problems in sufficient detail to satisfy the needs of the critically ill patient in modern intensive care units throughout the world. Indeed, the editors are to be congratulated for their most laudable step forward in CCM by publishing this book on Critical Care Nephrology.
Ake Grenvik Professor Emeritus of Anesthesiology,
Medicine, and Surgery Director Multidisciplinary Critical
Care Training Program University of Pittsburgh Medical Centre
Pittsburgh, USA
Claudio Ronco & Rinaldo Bellomo (eds.). Critical Care Nephrology. xix. © 1998 Kluwer Academic Publishers.
Foreword: The Intensive Care Side
Critical Care Medicine is no longer a young specialty in medicine. Essentially, it was introduced in the 1950s with respiratory care and mechanical ventilation during the worldwide polio epidemics. Anesthesiologists were first involved both in Europe and in the United States through the 1960s and 70s, because of airway problems, use of ventilators and cardiopulmonary resuscitation, all activities familiar to the anesthesiologist from the operating room.
During the 1980s internists and pediatricians increasingly became interested and heavily involved in intensive care, especially in the United States. This interest was later shared by surgeons who, particularly in the 1990s, have become common critical care specialists in the ICU setting.
Gradually, pulmonologists, cardiologists, neurologists, neurosurgeons, cardiothoracic surgeons, traumatologists and transplant surgeons have demonstrated particular interest in the management of their patients in the lCU. Nephrologists are not yet common amongst critical care specialists but most critically ill and injured patients, with time, develop renal failure. Nephrologists are then called upon as consultants to deal with specific renal problems, especially when dialysis becomes necessary, which is common in intensive care.
Respiratory intensive care, critical care cardiology and pediatric critical care, medical and surgical critical care have all been addressed in a number of different textbooks, some of them currently in preparation of a fourth edition, which indicates that the subspecialty of CCM is coming of age. Throughout these years, however, there has not been a good quality and extensive book on the specific problems related to renal disease in critical illness. It is against this background, that Drs Ronco and Bellomo decided to gather a number of renowned ICU physicians, surgeons, and nephrologists with special interest in critical care, and patients with multiple organ failure, practically always including the kidneys, to produce a comprehensive text written especially for intensivists and nephrologists dealing with these patients.
This critical care nephrology text provides thorough
Claudio Ronco & Rinaldo Bellomo (eds,J. Crilical Care Nephrology, xix. © 1998 Kluwer Academic Puhlishers.
background information on those critically ill patients, who commonly develop renal disease for a complete understanding of the underlying disease mechanisms, pathophysiology and of how best to diagnose and manage renal failure in these patients. The editors have succeeded in providing a most useful book which, in detail, discusses the underlying problems and the appropriate use of renal replacement therapy in the presence of very complex situations, varying from trauma and cardiorespiratory failure to transplantation of different organs, not only the kidney itself, and use of artificial organs. Infections are common in all critically ill patients and this also is dealt with in admirable detail. Pre-renal, renal and post-renal kidney failure patients all receive detailed discussion, as well as the pros and cons of potentially nephrotoxic drugs, such as antibiotics and immunosuppressive drugs.
It should be clear from the above description that this book is a welcome addition to the critical care literature. While it may primarily be directed to intensivists and nephrologists with interest in the critically ill patient, many others will find this book an excellent source of references , which should find its way to each lCU in the world. Increasingly, knowledgeable ICU nurses may also wish to learn more about their problem patients. Thus, it is anticipated that this book will be most appreciated as an important contribution to existing broader textbooks on critical care at large. None of these deal with renal problems in sufficient detail to satisfy the needs of the critically ill patient in modern intensive care units throughout the world. Indeed, the editors are to be congratulated for their most laudable step forward in CCM by publishing this book on Critical Care Nephrology.
Ake Grenvik Professor Emeritus of Anesthesiology,
Medicine, and Surgery Director Multidisciplinary Critical
Care Training Program University of Pittsburgh Medical Centre
Pittsburgh, USA
Preface
The continuous evolution of medicine, opens new areas of interest. The state of progress in such areas must, at times, be adequately reviewed by experts with appropriate reference tools and information sources. It is only by clearly knowing where we are that we can move forward with purpose and insight.
After much clinical and experimental research experience in the field of critical care medicine and nephrology, we have decided to undertake the task of editing a comprehensive book dealing with these two very subjects as they interact in the experimental and clinical environments. In our view, there are several reasons to justify such an effort. A common view of how the basic sciences in critical care medicine and nephrology interact is presently missing. Practice guidelines, expert-based approaches, and appropriate literature analyses dealing with a multidisciplinary approach to kidney diseases in critically ill patients are also lacking. Internists, surgeons, critical care physicians or nephrologists, all treat critically ill patients with renal failure and the multiple system organ dysfunction syndrome. The approach, however, varies from hospital to hospital and from physician to physician, often on the basis of the need to somehow treat rather than because of mature and full interest and comprehensive knowledge. Patient management frequently depends on the political structure of the institution, the traditions of the medical school, or the financial and political status of the institution or faculty . Doctors from different fields see patients and prescribe therapies without searching for a common multidisciplinary approach to the patient. Often, they barely meet at the bedside and various prescriptions are made in the absence of a common decision making process or adequate communication. Nephrologists often do not appreciate the significance of critical care monitoring techniques and therapies and critical care physicians often fail to appreciate the important contribution the nephrologist can make to the care of the patient. Evidence-based patient care is sometimes applied but often replaced by practice based on anecdotes. Finally, despite the fact that acute renal dysfunction is very common in acutely ill patients,
there is no recognition that its management requires a unique level of expertise and that the vastness of knowledge necessary for state-of-the-art practice requires specific commitment and interest.
For the above reasons, we believe that the time has come for a comprehensive review of this area of medicine both from an academic and clinical point of view. The book Critical Care Nephrology, we hope, will provide such a comprehensive review of this new combined area of medicine. This book should thus become a useful reference tool both for nephrologists and intensivists as they deal with the management of renal problems in acutely ill patients. It is therefore not a coincidence that one editor of the present book is a nephrologist and the other an intensivist.
The book is aimed at creating a complete reference source for those colleagues who are frequently involved in the care of acutely ill patients suffering from kidney diseases, electrolyte and metabolic imbalances, poisoning, multiorgan failure, septic shock, acid-base disorders, and other pathophysiologic events that involve the kidney and that require a multidisciplinary approach and a broad but specific knowledge. We also believe that this book will be an invaluable educational tool for Nephrology and Critical Care/lntensive Care trainees who should significantly benefit from the wide spectrum of information provided by this book. Finally, we hope that this book will accelerate the process of developing common practice guidelines in nephrology and critical care medicine, so that physicians from different specialties think in a similar way and speak the same language.
The title "Critical Care Nephrology" has been chosen to stress the aim of the book which is to provide a comprehensive review of the problems related to kidney diseases in critically ill patients. Thus the book deals with the pathophysiologic foundations of major renal and ICU syndromes, clinical approaches to shock, interactions between renal and other organ system failure, oxygen transport and cardiovascular adaptations, hemodynamic and respiratory issues, principles of" mechanical ventilation, severity of illness assessment and cardiovascular
Claudio Ronco & Rinaldo Bellomo (eds.). Critical Care Nephrology. xxi-xxii.
XXll
support, adequate monitoring techniques, therapeutic interventions aimed at organ support, and management of various conditions which directly or indirectly involve the kidney during acute illness. The title is also intended to draw the reader's attention to the multidisciplinary nature of this complex subject matter and to the need for maximal cooperation between experts from intensive care and nephrology. The book also deals in detail with all forms of acute renal failure with specific reference to intensive care patients. Prerenal, renal, and post renal acute renal failure are discussed in terms of etiology, incidence, mechanisms, pathophysiology, tissue lesions, biopsy patterns, diagnostic procedures, and therapies.
The nature of the multiple organ dysfunction syndrome is discussed with special emphasis on the impact of different organ dysfunctions and kidney failure. Poisoning, infections (in general and of the urinary tract), drug-induced renal failure, and sepsis are also discussed focussing on the pathophysiologic foundations of these syndromes. Kidney function and acute renal failure in patients with kidney, liver and heart transplants are also covered in detail. Acute illness occurring in chronic hemodialysis patients has also been considered. Finally, renal disease in special patients such as children, diabetics and elderly subjects is presented and discussed.
Special emphasis has been placed on therapeutic interventions and treatment procedures. Different forms of organ support are discussed including advanced liver, lung and cardiac support. Renal support is conceived in terms of preventive measures to avoid renal failure and supportive treatment to replace renal function in different conditions. Therefore, the use and kinetics of drugs in the critically ill patient are explored. The various forms of extracorporeal therapies are discussed in detail including hemodialysis, hemofiltration, hemoperfusion and extracorporeal membrane oxygenation. Mechanical ventilation, mechanical cardiac support, and the total
PREFACE
artificial heart are discussed in relation to kidney function. Recent advances in the therapy of the sepsis syndrome are presented and new insights on future trends in terms of extracorporeal treatments have been provided.
The book is divided into sections. Each section includes a given number of chapters depending on the subject. Section editors have been asked to organize the structure of the section and the number and titles of the chapters. Chapter authors have been chosen jointly with the chief editors and selected among experts in each specific field.
We are indebted to all contributors and scientists whose work has allowed us to complete this difficult task. We would also like to sincerely thank Kluwer Academic Publishers and all those persons who have dedicated their skill, intelligence and work to help make this book of outstanding editorial quality. We also wish to express our gratitude to Nephroprogress s.r.l. Vicenza, for the invaluable organizational and editorial support and to Prof. Schrier and Prof. Grenvik for their comments and forewords. We would also like to acknowledge the support of our colleagues, our nurses, and all those persons who have given their patience, support, advice, and friendship during the preparation of the book. We have spent more than three years of our academic life in the preparation of this textbook and we sincerely hope that our efforts will contribute in some way toward making the clinical work of our colleagues easier.
We hope that the book will stimulate the development of new ideas, of a new approach to scientific research in this field, and most of all, that it will contribute to improved care for our patients through a more collaborative approach between nephrologists and intensive care physicians.
Claudio Ronco Rinaldo Bellomo
List of Contributors
Ian C. Abbs Department of Renal Medicine Guy's Hospital London UK
Jean M. Achard Nephrology and Intensive Care Unit CHR Amiens-Sud Amiens France
Anupam Agarwal Department of Medicine Division of Nephrology, Hypertension &
Transplantation University of Florida Medical School Gainesville, FL USA
Anders Alvestrand, MD, PhD Division of Renal Medicine Department of Clinical Science Huddinge University Hospital Karolinska Institute Stockholm Sweden
Michele Andreucci Division of Nephrology School of Medicine University Federico II of Naples Naples Italy
Vittorio Emanuele Andreucci Division of Nephrology School of Medicine University Federico II of Naples Naples Italy
Derek C. Angus, MB, ChB, MPH Health Division and Systems Evaluation Department of Anesthesiology and Critical
Care Medicine University of Pittsburgh Pittsburgh, PA USA
Allen I. Arieff, MD Department of Medicine Geriatrics Section Veterans Affairs Medical Center University of California at San Francisco San Francisco, CA USA
Vicente Arroyo Liver Unit Hospital Clinic Provincial University of Barcelona Barcelona Spain
Ian C. Baldwin Nursing Education Unit Intensive Care Unit Austin and Repatriation Medical Centre Melbourne Australia
Peter Barany, MD, PhD Division of Renal Medicine Department of Clinical Science Huddinge University Hospital Karolinska Institute Stockholm Sweden
Laurent Baud INSERM U64 H6pital Tenon Paris France
Claudio Ronco & Rinaldo Bellomo (eds.), Critical Care NeDhrolOPv. xxiii - xxxv
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Mark C. Bellamy, MA, FRCA St. James's University Hospital N.H.S. Trust Leeds UK
Vicenzo Bellizi Division of Nephrology School of Medicine University Federico II of Naples Naples Italy
Rinaldo Bellomo, MBBS, MD, FRACP Intensive Care Unit Austin and Repatriation Medical Centre Melbourne Australia
Jean J. Beraud, MD Metabolic Intensive Care Unit Lapeyronie University Hospital Montpellier France
Jonas Bergstrom Institute of Renal Medicine Huddinge University Hospital Huddinge Sweden
Jacques Bernheim Department of Nephrology and Hypertension Meir Hospital Kfar Saba Israel
Andrew D. Bersten Department of Critical Care Medicine Intensive Care Unit Flinders Medical Center South Australia Australia
Luigi Biancone Division of Nephrology Department of Science Faculty of Medicine University of Pavia Varese Italy
David Bihari, FRACP Intensive Care Unit St. George Hospital Kogarah Australia
LIST OF CONTRIBUTORS
Geoffrey A. Block, MD Division of Nephrology Department of Internal Medicine University of Michigan Medical Center Ann Arbor, MI USA
Walther H. Boer Department of Nephrology University Hospital Utrecht The Netherlands
Giovanna Bonoldi Division of Nephrology St. Gerardo Hospital Monza Italy
Jean-Yves Bose Department of Nephrology Lapeyronie University Hospital Montpellier France
Juan P. Bosch Department of Nephrology and Hypertension George Washington University Hospital Washington, DC USA
Edmund Bourke, MD Medical Service Brooklyn VA Medical Center New York, NY USA
John J. Brady, MD Kent County Medical Hospital Providence, RI USA
Alessandra Brendolan, MD Division of Nephrology st. Bartolo Hospital Vicenza Italy
LIST OF CONTRIBUTORS
Nicholas P. Bridge Nursing Education Unit Intensive Care Unit Austin and Repatriation Medical Centre Melbourne Australia
Jonathan N. Buckmaster, MB, BS, FFICANZCA
Intensive Care Unit Austin and Repatriation Medical Centre Melbourne Australia
Hilmar Burchardi Zentrum Anaesthesiologie Rettungs- und Intensivmedizin Klinikum der Georg-August Universitat Gottingen Germany
Eckhart Bussemaker Division of Nephrology Department of Medicine University Clinic C.G. Clarus Dresden Germany
J. Stewart Cameron Clinical Sciences Lab. 17th Floor Guy's Tower Guy's Hospital London Bridge London UK
Giovanni Camussi Division of Nephrology Department of Science Faculty of Medicine University of Pavia Hospital of Circolo Varese Italy
Bernard Canaud, MD Department of Nephrology Lapeyronie University Hospital Montpeflier France
Noel Cano Clinique Residence du Parc Marseille France
May T. Chow Department of Medicine Veterans Affairs Hospital Hines and Loyola University Chicago Stritch School of Medicine Maywood,IL USA
Gilles Clermont, Msc, MD, CM Critical Care Medicine Presbyterian University Hospital Pittsburgh, PA USA
Giuseppe Conte Division of Nephrology School of Medicine Second University of Naples Naples Italy
Robert E. Cronin, MD University of Texas Southwestern Medical
Center Dallas, TX USA
Mario Cruciani Department of Infectious Diseases University of Verona Verona Italy
Allan D. Cumming Department of Medicine Royal Infirmary Edinburgh UK
Kathleen Daly, SRN, Bsc Department of Intensive Care Guy's Hospital London UK
Andrew Davenport Royal Free Hospital London UK
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Andrew R. Davies, MB, BS, FRACP Intensive Care Unit Austin and Repatriation Medical Centre Melbourne Australia
Alex M. Davison Department of Nephrology St. James University Hospital Leeds UK
Marc E. De Broe Department of Nephrology-Hypertension University of Antwerp Antwerp Belgium
Bertrand deCagny Nephrology and Intensive Care Units University Hospital Amiens France
Fausto De Lalla Department of Infectious Diseases St. Bortolo Hospital Vicenza Italy
Luca De Nicola Division of Nephrology School of Medicine University Federico II of Naples Naples Italy
Beatrice Descamps-Latscha, MD, PhD Inserm U25 Department of Nephrology Necker Hospital Paris France
Patrick C. D'Haese Department of Nephrology and Hypertension University of Antwerp Antwerp Belgium
Salvatore Di Filipo Department of Nephrology General Hospital Lecco Italy
Gerhard Dilda Mathematik and EDV Aldenhoven Germany
Donato Donati Division of Nephrology Department of Science Faculty of Medicine University of Pavia Varese Italy
Wilfred Druml
LIST OF CONTRIBUTORS
Division of Nephrology Vienna School of Medicine Vienna General Hospital Vienna Austria
Richard M. Effros, MD Department of Medicine Medical College of Wisconsin Milwaukee, WI USA
Tania D. Elderkin Intensive Care Unit Austin and Repatriation Medical Centre Melbourne Australia
Najeh EI Esper Nephrology and Intensive Care Unit CH R Amiens-Sud Amiens France
Haskel Eliahou Internal Medicine, Nephrology and Hypertension Ramat-Gan Israel
Zoltan H. Endre, MBBS, PhD, FRACP Department of Medicine The University of Queensland Clinical Sciences Building Royal Brisbane Hospital Brisbane, Queensland Australia
LIST OF CONTRIBUTORS
Silvano Esposito Department of Infectious Diseases Second University of Naples Naples Italy
Aldo Fabris Division of Nephrology City Hospital Bassano del Grappa Vicenza Italy
Mariano Feriani Department of Nephrology St. Bortolo Hospital Vicenza Italy
Richard N. Fine, MD Department of Pediatrics SUNY at Stony Brook School of Medicine Pediatric Dialysis Unit Health Sciences Center Stony Brook, NY USA
Michael F. Flessner Nephrology Unit Department of Medicine University of Rochester Medical Center Rochester, NY USA
Guglielmo Fodor, MD Division of Radiology Regional Hospital Balzano Italy
David M. Forrest, MD Critical Care Medicine St. Pauls Hospital University of British Columbia Vancouver Canada
Albert Fournier Nephrology and Intensive Care Unit University Hospital Amiens France
Cosmo L. Fraser, MD Department of Medicine Geriatrics Section Veterans Affairs Medical Center University of California at San Francisco San Francisco, CA USA
Eli A. Friedman, MD, FACP SUNY Health Science Center at Brooklyn Brooklyn, NY USA
Giorgio Fuiano Division of Nephrology University of Reggion Calabria Catanzaro Italy
Peter Furst, MD, PhD
xxvii
Institute of Biological Chemistry and Nutrition University of Hohenheim Stuttgart Germany
Vasant C. Gandhi Department of Medicine Veterans Affairs Hospital Hines and Loyola University Chicago Stritch School of Medicine Maywood,IL USA
Reinold O.B. Gans Department of Medicine VU Hospital Amsterdam The Netherlands
Claudio Gardin Division of Nephrology City Hospital Bassano del Grappa Italy
Serafino Garella, MD, FACP Department of Medicine Northwestern University Saint Joseph Health Centers & Hospital Chicago, IL USA
xxviii
Laurie Garred, PhD Department of Chemical Engineering Lakehead University Thunder Bay Ontario Canada
Abdul K. Garuba Division of Critical Care Medicine University of Pittsburgh Medical Center Pittsburgh, PA USA
Luigi Gastaldi Division of Nephrology Department of Science Faculty of Medicine University of Pavia Hospital of Circolo Varese Italy
Luciano Gattinoni Institute of Anesthesiology and
Critical Care University of Milan Milan Italy
Bruno Giacon, MD Division of Nephrology Regional Hospital Solzano Italy
Pere Gines Liver Unit Hospital Clinic Provincial Barcelona Spain
Jane Goddard Department of Medicine The University of Edingburgh Royal Infirmary Edinburgh Scotland
Sharad Goel, MD, MRCP Division of Nephrology Department of Internal Medicine University of Missouri Health Sciences Center Columbia, MO USA
LIST OF CONTRIBUTORS
Thomas A. Golper, MD, FACP Division of Nephrology University of Arkansas for Medical Sciences Little Rock, AK USA
Hilary P. Grocott, MD, FRCPC Department of Anesthesiology Surgical ICU Duke University Medical Center Durham, DC USA
Peter Gross Division of Nephrology Department of Medicine University Clinic C.G. Carus Dresden Germany
Bertrand Guidet Service de Reanimation et Hospitalisation
des Urgences Saint-Antoine Hospital Paris France
Marianne Haag-Weber Division of Nephrology University Clinic of Medicine III University of Vienna Vienna Austria
Mark J. Heulitt, MD Arkansas Children's Hospital University of Arkansas for Medical Sciences Little Rock, AK USA
Andrew W. Holt Department of Critical Care Nephrology Flinders Medical Centre Adelaide Australia
Walter H. Horl Division of Nephrology and Dialysis University Clinic of Medicine III University of Vienna Vienna Austria
LIST OF CONTRIBUTORS
Eric Hoste Department of Nephrology University Hospital Gent Belgium
Adrian laina Department of Nephrology Tel Aviv Medical Center Tel Aviv Israel
Gaetano lapichino Division of Anesthesiology and
Reanimation San Paolo Hospital Milan Italy
Todd S. In9 Department of Medicine Veterans Affairs Hospital Hines and Loyola University Chicago Stritch School of Medicine Maywood,IL USA
Van ita Jassal, MD, MRCP (UK) Division of Nephrology The Wellesley Hospital University of Toronto Toronto Canada
Randall D. Jenkins, MD Department of Pediatrics Emanuel Children's Hospital Portland, OR USA
John P. Johnson Renal Electrolyte Division Department of Medicine University of Pittsburgh Medical Center Pittsburgh, PA USA
Didier Journois Department of Anesthesiology and Intensive
Care Laennec Hospital Paris France
Paul Jungers, MD Department of Nephrology Necker Hospital Paris France
Gabriele Kaczmarczyk
xxix
Working Group on Experimental Anesthesiology University Hospital Charite Virchow Clinic Berlin Germany
Andre A. Kaplan, MD, FACP Dialysis Program University of Connecticut Health Center John Dempsey Hospital Farmington, CT USA
Frederick J. Kaskel, MD, PhD Pediatric Dialysis Unit Division of Pediatric Nephrology University Medical Center at Stony Brook Health Sciences Center Stony Brook, NY USA
John A. Kellum, MD Division of Critical Care Medicine University of Pittsburgh Medical Center Pittsburgh, PA USA
James H. Kelly Amphioxus Cell Technologies Houston, TX USA
Saulo Klahr Department of Internal Medicine Washington University Medical Center Jewish Hospital of St. Louis St. Louis, MO USA
Dieter Kleinknecht Service de Nephrologie et de Reanimation
Polyvalente Centre Hospitalier Montreuil France
xxx
Kada Klouche, MD Metabolic Intensive Care Unit Lapeyronie University Hospital Montpellier France
Jeroen P. Kooman, MD, PhD Department of Internal Medicine University Hospital Maastricht Maastricht The Netherlands
Hein A. Koomans Department of Nephrology University Hospital Utrecht The Netherlands
Martin o. Krebs Working Group on Experimental Anesthesiology University Hospital Charite Virchow Clinic Berlin Germany
Raymond T. Krediet, MD, PhD Renal Unit Academic Medical Center Amsterdam The Netherlands
Giuseppe LaGreca Division of Nephrology St. Bortolo Hospital Vicenza Italy
Norbert Lameire, MD Department of Nephrology University Hospital Gent Belgium
Martine Leblanc, MD, FRCPC, FACP Department of Nephrology and
Critical Care University of Montreal Montreal, Quebec Canada
David J. Leehey Veterans Affairs Hospital Hines and Loyola University Chicago Stritch School of Medicine Maywood,IL USA
LIST OF CONTRIBUTORS
He IEme Leray-Moragues, MD Department of Nephrology Lapeyronie University Hospital Montpellier France
Karel M.L. Leunissen, MD, PhD Department of Nephrology University Hospital Maastricht Maastricht The Netherlands
Xavier M. Leverve Laboratoire de Bioenergetique
fondamentale et appliquee Universite Joseph Fourier Grenoble France
Fernando Liano Department of Nephrology Hospital Ramon y Cajal Madrid Spain
Peter Linden, MD Division of Critical Care Medicine University of Pittsburgh Medical Center Pittsburgh, PA USA
Alfredo Lissoni Institute of Anesthesiology and
Critical Care University of Milan Milan Italy
Francesco Locatelli Department of Nephrology General Hospital Lecco Italy
J. Peter A. Lodge, MD, FRCS St. James University Hospital Department of Surgery and Intensive Care Leeds UK
Gerard M. London MANHES Hospital Fleury-Merogis France
LIST OF CONTRIBUTORS
Sheldon Magder, MD Critical Care Division Royal Victoria Hospital McGill University Montreal, Quebec Canada
Marina Malena Department of Infectious Diseases University of Verona Verona Italy
Filippo Mariano Department of Nephrology Civil Hospital Alba Italy
James Marshall, MD Children'S Mercy Hospital University of Missouri Kansas City, MO USA
Michael A. Marx, Pharm D, BCPS Department of Pharmacy Practice University of Arkansas for Medical Sciences Little Rock, AK USA
Navdeep K. Mehta Division of Critical Care Medicine Presbyterian University Hospital Pittsburgh, PA USA
Ravindra L. Mehta, MD, FACP Department of Medicine UCSD Medical Center San Diego, CA USA
Charles Mion, MD Hopital Lapeyronie Universite de Montpellier Montpellier France
Philippe Moriniere Nephrology and Intensive Care Unit University Hospital Amiens Amiens France
Allen R. Nissenson Department of Nephrology UCLA 200 Medical Plaza Los Angeles, CA USA
Karl D. Nolph, FACP, FRCPS Division of Nephrology Department of Internal Medicine University of Missouri Health Science Center Columbia, MO USA
Marina Noris, Chem Pharm D Mario Negri Institute for Pharmaceutical
Research Bergamo Italy
Andrea Noto Division of Anesthesiology and Reanimation San Paolo Hospital Milan Italy
Stephan R. Orth Department of Internal Medicine Ruperto Carola University Heidelberg Heidelberg Germany
Hartmut Osswald Department of Pharmacology University of Tubingen Tubingen Germany
Paul M. Palevsky, MD Renal Electrolyte Division Department of Medicine University of Pittsburgh School of Medicine Pittsburgh, PA USA
Mark S. Paller, MD Department of Medicine University of Minnesota Minneapolis, MN USA
XXXI
xxxii
Jens Passauer Nephrology Department of Medicine University Clinic C.G. Clarus Dresden Germany
Gari Peer Department of Nephrology Tel Aviv Medical Center Tel Aviv Israel
Maria Valentina Pellanda Division of Nephrology City Hospital Bassano del Grappa Italy
Giampietro Pellizzer Department of Infectious Diseases St. Bortolo Hospital Vicenza Italy
Andreas Pierratos, MD, FRCPC Division of Nephrology The Wellesley Hospital University of Toronto Toronto Canada
Michael R. Pinsky, MD Critical Care Medicine Presbyterian University Hospital Pittsburgh, PA USA
Eric Playe Department of Anesthesiology and Intensive
Care Medicine Laennec Hospital Paris France
Eduardo Podjarny Department of Nephrology and HypertenSion Sapir Medical Center Meir Hospital Kfar Saba Israel
LIST OF CONTRIBUTORS
Giuseppe Pontoriero Department of Nephrology General Hospital Lecco Italy
Kenneth W. Presberg, MD Pulmonary and Critical Care Division Medical College of Wisconsin Milwaukee, WI USA
Sayeed Qazi Division of Nephrology Georgetown University Medical Center Washington, DC USA
Lorraine C. Racusen, MD Department of Physiology Johns Hopkins Medical Institutions Baltimore, MD USA
Danilo Radrizzani Department of Anesthesiology and Reanimation San Paolo Hospital Milan Italy
Leopoldo Raij Department of Medicine Veterans Affairs Medical Center Minneapolis, MN USA
Charles A. Read, MD, FCCP Division of Pulmonary Diseases and
Critical Care Medicine Georgetown University Medical Center Washington, DC USA
Bruno Redaelli Department of Nephrology General Hospital Monza Italy
Giuseppe Remuzzi Institute Mario Negri Bergamo Italy
LIST OF CONTRIBUTORS
Eberhard Ritz Department of Internal Medicine Ruperta Carola University Heidelberg Heidelberg Germany
Claudio Ronco, MD Department of Nephrology St. Bartolo Hospital Vicenza Italy
Stephen G. Rostand, MD Division of Nephrology Department of Medicine University of Alabama at Birmingham Birmingham, AL USA
James A. Russell, MD Department of Medicine St. Pauls Hospital University of British Columbia Vancouver Canada
Edwin A. Rutsky, MD Division of Nephrology Department of Medicine Birmingham University Station Birmingham, AL USA
Rajiv Saran, MD, MRCP Division of Nephrology Department of Internal Medicine University of Missouri Health Sciences Center Columbia, MO USA
Judy Savige Renal Unit and University Department of
Medicine Austin and Repatriation Medical Centre Melbourne Australia
Martin Schadt Department of Nephrology University Clinic B. Franklin Berlin Germany
Jeffrey R. Schelling Case Western Reserve University School
of Medicine Cleveland, OH USA
Miet Schetz Intensive Care Unit University Hospital Leuven Leuven Belgium
Daniel P. Schuster, MD Respiratory and Critical Care Division Washington University School of Medicine St. Louis, MO USA
Richard D. Schwartz, MD Department of Medicine SUNY at Stony Brook Stony Brook, NY USA
John R. Sedor Department of Medicine University School of Medicine Rammelkamp Center for Research MetroHealth Medical Center Cleveland, OH USA
Pesach Segal Diabetes Unit Chaim Sheba Medical Center Tel-Hashomer Israel
James Y. Shin, MD Department of Veterans Affairs Medical Center Dallas, TX USA
Heinz-Gunther Sieberth Medizinischen Klinik " Technical University of Aachen Aachen Germany
William Silvester, MBBS, FRACP Intensive Care Unit Austin & Repatriation Medical Centre Melbourne Australia
xxxiii
XXXIV
Robert N. Siaden, MB, ChB, MRCP (UK), FRCPC
Department of Anesthesiology Division of Cardiac Anesthesiology Duke University Medical Center Durham, DC USA
Kim Solez Department of Laboratory Medicine
and Pathology University of Alberta Mackenzie Health
Sciences Centre Edmonton Alberta Canada
Pau Sort Liver Unit Hospital Clinic Provincial Barcelona Spain
Aaron Spital, MD University of Rochester School of Medicine The Genesee Hospital Rochester, NY USA
T.K. Sreepado Rao, MD, FACP Department of Medicine SUNY Health Science Center at Brooklyn Brooklyn, NY USA
Peter Stenvinkel, MD, PhD Department of Renal Medicine Huddinge University Hospital Karolinska Institute Huddinge Sweden
Charles I. Stewart, MD Pediatric Dialysis Unit Division of Pediatric Nephrology University Medical Center at Stony Brook Health Sciences Center Stony Brook, NY USA
Norman L. Sussman Amphioxus Cell Technologies Houston, TX USA
LIST OF CONTRIBUTORS
Angelo M. Taveira-Da Silva, MD, PhD Medical Intensive Care Unit Georgetown University Medical Center Washington, DC USA
Ciro Tetta Bellco Laboratories Bellco S.pA Mirandola Italy
Lambert G. Thijs VU Hospital Amsterdam The Netherlands
Volker Vallon Department of Pharmacology Medical Faculty University of Tubingen Tubingen Germany
Raymond Van holder Department of Nephrology University Hospital Gent Belgium
Stephen I. Vas, MD, PhD, FRCP Department of Microbiology
and Medicine Toronto Western Hospital Toronto, Ontario Canada
Jean-Louis Vincent Department of Intensive Care Erasme University Hospital Free University of Brussels Brussels Belgium
Keith R. Walley, MD Department of Medicine St. Pauls Hospital University of British Columbia Vancouver Canada
Hans Joachim Weber University of Technology Aachen Germany
LIST OF CONTRIBUTORS
Pieter M. ter Wee Department of Internal Medicine VU Hospital Amsterdam The Netherlands
Dierk Werner Cardiology Department of Medicine University Clinic C.G. Clarus Dresden Germany
Pierre F. Westeel Nephrology and Intensive Care CHR Amiens-Sud Amiens France
James F. Winchester Division of Renal Diseases Georgetown University Medical Center Washington, DC USA
David Windus, MD Pulmonary and Critical Care Division Washington University School of Medicine St. Louis, MO USA
Volker Wizemann George-Haas Dialyses Center Giessen Germany
Joseph C.H. Wong, MBBS, FRACP Department of Nuclear Medicine Royal Brisbane Hospital Brisbane, Queensland Australia
Martin Zeier Department of Internal Medicine Ruperto Carola University Heidelberg Heidelberg Germany
Lothar ZO lIer Department of Internal Medicine Ruperto Carola University Heidelberg Germany
xxxv
