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Review
. 2017 Jun;43(6):816-828.
doi: 10.1007/s00134-017-4755-7. Epub 2017 Mar 31.

Acute kidney injury in sepsis

Rinaldo Bellomo  1   2 , John A Kellum  3 , Claudio Ronco  4   5 , Ron Wald  6   7 , Johan Martensson  8 , Matthew Maiden  9   10 , Sean M Bagshaw  11 , Neil J Glassford  12   13 , Yugeesh Lankadeva  14 , Suvi T Vaara  15 , Antoine Schneider  16
Affiliations
Review

Acute kidney injury in sepsis

Rinaldo Bellomo et al. Intensive Care Med. 2017 Jun.

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.

Keywords: Acute kidney injury; Biomarkers; Creatinine; Recovery; Renal replacement therapy; Sepsis.

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References

    1. Crit Care. 2013 Feb 06;17(1):R25 - PubMed
    1. Crit Care Med. 2012 Apr;40(4):1164-70 - PubMed
    1. Kidney Int. 2014 Mar;85(3):659-67 - PubMed
    1. Intensive Care Med. 2013 Sep;39(9):1535-46 - PubMed
    1. Intensive Care Med. 2017 Jan 30;: - PubMed

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