Acute kidney injury in sepsis.

Détails

ID Serval
serval:BIB_60F530FED5C1
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Institution
Titre
Acute kidney injury in sepsis.
Périodique
Intensive care medicine
Auteur(s)
Bellomo R., Kellum J.A., Ronco C., Wald R., Martensson J., Maiden M., Bagshaw S.M., Glassford N.J., Lankadeva Y., Vaara S.T., Schneider A.
ISSN
1432-1238 (Electronic)
ISSN-L
0342-4642
Statut éditorial
Publié
Date de publication
06/2017
Peer-reviewed
Oui
Volume
43
Numéro
6
Pages
816-828
Langue
anglais
Notes
Publication types: Journal Article ; Review
Publication Status: ppublish
Résumé
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.

Mots-clé
Acute Kidney Injury/etiology, Acute Kidney Injury/therapy, Biomarkers/blood, Creatinine/blood, Critical Care/methods, Humans, Intensive Care Units, Kidney/physiopathology, Kidney Function Tests, Renal Replacement Therapy/methods, Sepsis/complications, Acute kidney injury, Biomarkers, Creatinine, Recovery, Renal replacement therapy, Sepsis
Pubmed
Web of science
Création de la notice
04/07/2017 11:39
Dernière modification de la notice
20/08/2019 15:18
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