Non-dialytic management of sepsis-induced acute kidney injury.
Sepsis is an important cause of morbidity and mortality. Acute Kidney Injury (AKI) often complicates sepsis, leading to greater complexity, higher cost of care and worsening prognosis. Despite the improved understanding of its underlying pathophysiological basis, there have been very few interventions, which have consistently been shown to be of value in the management of sepsis-induced AKI. Measures such as adequate hydration, maintenance of adequate circulating blood volume and mean arterial pressure, and avoidance of nephrotoxins, are still the mainstay of prevention. Loop diuretics, mannitol and "low dose" dopamine have been clearly shown to be of no value in the prevention or treatment of AKI and may, in fact, do harm. Among the remaining pharmacological options, N-acetylcysteine (NAC) may have a role in the prevention of radiocontrast induced AKI.
Faculty of Medicine, University of Colombo, Colombo, Sri Lanka. senaka.ucfm@gmail.com
Senaka
S
Rajapakse
Eranga S
ES
Wijewickrama
D000111:Acetylcysteine / Q000627:therapeutic use; D000208:Acute Disease; D003287:Contrast Media / Q000009:adverse effects; D004298:Dopamine / Q000009:adverse effects / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005440:Fluid Therapy; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007674:Kidney Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D009997:Osmotic Pressure; D010477:Perfusion; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use
D003287:Contrast Media; D007004:Hypoglycemic Agents; D007328:Insulin; D049994:Sodium Potassium Chloride Symporter Inhibitors; D014662:Vasoconstrictor Agents; D004298:Dopamine; D000111:Acetylcysteine