Читать книгу Emergency Medical Services - Группа авторов - Страница 472

According to the 2019 United States Renal Data System annual report, close to 750,000 people in the United States are living with end‐stage kidney disease (ESRD). Of those receiving treatment, 63% were undergoing hemodialysis, 7% peritoneal dialysis, and 30% had functional transplanted kidneys. While the number of prevalent cases continues to rise, the incidence of new cases has plateaued, owing to an increased number of patients starting renal replacement therapy, increased survival rates, and longer life expectancy of this population [1]. With the increasing number of ESRD patients potentially using the EMS system, the EMS physician must ensure that education about renal emergencies is an integral part of training and protocols.

Receiving approximately 20% of the body’s cardiac output, the kidneys function to filter blood through their 2 million nephrons. The series of microscopic and macroscopic elements serve to filter waste, complex metabolites, and excess fluids, exchange electrolytes, and manage acid and base regulation with the resultant fluid being excreted from the nephron. Additionally, the kidney controls red blood cell production with the production of erythropoietin and has a role in blood pressure regulation through renin secretion. Renal function is largely defined by estimated glomerular filtration rate in milliliter/minute/1.73 m² (body surface area), with lesser values corresponding to more severe renal impairment [2].

Renal failure encompasses the entire spectrum of kidney malfunction including acute kidney injury, chronic kidney disease (CKD), and ultimately ESRD. Progression between acute and chronic disease is patient‐specific, dependent on several factors, including etiology of renal insult, reversibility of damage, and timeliness of treatment. While the specific pathophysiology differentiating each stage of disease will not be covered in this chapter, it is imperative for the EMS clinician to be able to identify and manage the emergent clinical presentations associated with renal failure.