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Stratégie diagnostique de l’insuffisance rénale aiguë en réanimation

Diagnostic strategies for renal impairment in the intensive care unit

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Réanimation

Résumé

L’insuffisance rénale aiguë (IRA) en réanimation est une entité fréquente, qui s’intègre souvent dans un contexte d’agression rénale aiguë, dont les états de choc sont les principaux pourvoyeurs. Toutefois, l’IRA en réanimation peut être le symptôme d’une pathologie sous-jacente spécifique, dont le diagnostic et la prise en charge représentent un enjeu conditionnant le pronostic fonctionnel et vital du patient. L’objectif de cette revue est de présenter au praticien les différentes étiologies d’IRA en réanimation, avec leurs caractéristiques épidémiologiques, cliniques et paracliniques, ainsi que les moyens à sa disposition pour construire sa démarche diagnostique, en discutant leur validité chez le patient agressé de réanimation. L’anamnèse est une étape majeure de la réflexion clinique face à une IRA en réanimation ne s’intégrant pas dans le concept d’agression rénale aiguë. Enfin, la place et les indications de la ponction-biopsie rénale chez le patient de réanimation seront discutées.

Abstract

In the intensive care unit (ICU), most patients with high level of serum creatinine are now considered to have acute kidney injury (AKI). AKI results from several systemic aggressors such as sepsis, shock, or nephrotoxic drug. However, this may not be true in all patients. Indeed some ICU patients may suffer from a more specific form of acute renal failure. Prompt diagnosis and treatment are crucial for the prognosis of these patients. The aim of this article is to present an overview of renal failure that can be encountered in the ICU setting. It also aims at suggesting a diagnostic strategy taking into account the specificity of the ICU patients. Finally, the indications of renal biopsy in the critically ill patients are discussed.

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Authors and Affiliations

  1. Département de réanimation médicale et de médecine hyperbare, CHU d’Angers, 4, rue Larrey, F-49933, Angers cedex 09, France

    J. Demiselle, F. Beloncle, T. -H. Mezdad & N. Lerolle

  2. Néphrologie–dialyse–transplantation, CHU d’Angers, 4, rue Larrey, F-49933, Angers cedex 09, France

    J. Demiselle & J. -F. Augusto

Authors
  1. J. Demiselle
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  2. F. Beloncle
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  3. T. -H. Mezdad
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  4. J. -F. Augusto
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  5. N. Lerolle
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Correspondence to N. Lerolle.

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Demiselle, J., Beloncle, F., Mezdad, T.H. et al. Stratégie diagnostique de l’insuffisance rénale aiguë en réanimation. Réanimation 24, 625–635 (2015). https://doi.org/10.1007/s13546-015-1102-2

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  • DOI: https://doi.org/10.1007/s13546-015-1102-2

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