Acute kidney injury in sepsis

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Bellomo , R , Kellum , J A , Ronco , C , Wald , R , Martensson , J , Maiden , M , Bagshaw , S M , Glassford , N J , Lankadeva , Y , Vaara , S & Schneider , A 2017 , ' Acute kidney injury in sepsis ' , Intensive Care Medicine , vol. 43 , no. 6 , pp. 816-828 . https://doi.org/10.1007/s00134-017-4755-7

Title: Acute kidney injury in sepsis
Author: Bellomo, Rinaldo; Kellum, John A.; Ronco, Claudio; Wald, Ron; Martensson, Johan; Maiden, Matthew; Bagshaw, Sean M.; Glassford, Neil J.; Lankadeva, Yugeesh; Vaara, Suvi; Schneider, Antoine
Other contributor: University of Helsinki, Department of Diagnostics and Therapeutics



Date: 2017-06
Language: eng
Number of pages: 13
Belongs to series: Intensive Care Medicine
ISSN: 0342-4642
DOI: https://doi.org/10.1007/s00134-017-4755-7
URI: http://hdl.handle.net/10138/237045
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.
Subject: Sepsis
Acute kidney injury
Biomarkers
Creatinine
Renal replacement therapy
Recovery
RANDOMIZED CONTROLLED-TRIAL
CRITICALLY-ILL PATIENTS
INTENSIVE-CARE-UNIT
ACUTE-RENAL-FAILURE
GOAL-DIRECTED RESUSCITATION
SEPTIC SHOCK
BLOOD-FLOW
REPLACEMENT THERAPY
CLINICAL-TRIAL
CONSENSUS CONFERENCE
3121 General medicine, internal medicine and other clinical medicine
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