Austin Health

Title
Acute kidney injury in sepsis.
Publication Date
2017-06
Author(s)
Bellomo, Rinaldo
Kellum, John A
Ronco, Claudio
Wald, Ron
Martensson, Johan
Maiden, Matthew
Bagshaw, Sean M
Glassford, Neil J
Lankadeva, Yugeesh
Vaara, Suvi T
Schneider, Antoine
Subject
Acute kidney injury
Biomarkers
Creatinine
Recovery
Renal replacement therapy
Sepsis
Type of document
Journal Article
OrcId
0000-0002-1650-8939
0000-0001-8739-7896
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DOI
10.1007/s00134-017-4755-7
Abstract
Acute kidney injury (AKI) and sepsis carry consensus definitions. The simultaneous presence of both identifies septic AKI. Septic AKI is the most common AKI syndrome in ICU and accounts for approximately half of all such AKI. Its pathophysiology remains poorly understood, but animal models and lack of histological changes suggest that, at least initially, septic AKI may be a functional phenomenon with combined microvascular shunting and tubular cell stress. The diagnosis remains based on clinical assessment and measurement of urinary output and serum creatinine. However, multiple biomarkers and especially cell cycle arrest biomarkers are gaining acceptance. Prevention of septic AKI remains based on the treatment of sepsis and on early resuscitation. Such resuscitation relies on the judicious use of both fluids and vasoactive drugs. In particular, there is strong evidence that starch-containing fluids are nephrotoxic and decrease renal function and suggestive evidence that chloride-rich fluid may also adversely affect renal function. Vasoactive drugs have variable effects on renal function in septic AKI. At this time, norepinephrine is the dominant agent, but vasopressin may also have a role. Despite supportive therapies, renal function may be temporarily or completely lost. In such patients, renal replacement therapy (RRT) becomes necessary. The optimal intensity of this therapy has been established, while the timing of when to commence RRT is now a focus of investigation. If sepsis resolves, the majority of patients recover renal function. Yet, even a single episode of septic AKI is associated with increased subsequent risk of chronic kidney disease.
Link
Citation
Intensive Care Medicine 2017; 43(6): 816-828
Jornal Title
Intensive Care Medicine

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