Acute kidney injury in sepsis.

Details

Serval ID
serval:BIB_60F530FED5C1
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Acute kidney injury in sepsis.
Journal
Intensive care medicine
Author(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
Publication state
Published
Issued date
06/2017
Peer-reviewed
Oui
Volume
43
Number
6
Pages
816-828
Language
english
Notes
Publication types: Journal Article ; Review
Publication Status: ppublish
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/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
Create date
04/07/2017 10:39
Last modification date
20/08/2019 14:18
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