title: Protocoled resuscitation and the prevention of acute kidney injury.
abstract: OBJECTIVE
  Acute kidney injury (AKI) occurrence in critically ill patients is common and is associated with a substantial increase in morbidity and mortality. The scope of this review is to summarize the most recent evidence-based knowledge for prevention of AKI.
  
  
  RESULTS
  Recent recommendations for prevention of AKI in ICU patients are all 'negative' and, similarly, the most recent and updated guidelines about major topic areas of interest for AKI, including definition and classification, prevention, and pharmacologic treatment, have failed to identify single evidence-based recommendations for prevention and treatment of AKI. Therefore, the evaluation and management of AKI should be guided by clinical algorithms aiming to protocolized hemodynamic optimization, metabolic control, monitoring of intra-abdominal hypertension, use of diuretics to control fluid overload, and careful management of nephrotoxic factors.
  
  
  CONCLUSIONS
  Key components of optimal AKI prevention include maintenance of renal perfusion and avoidance of precipitating factors. Adequate renal blood flow maintenance is the first strategy to employ not only to assure renal oxygenation, but also to prevent nephrotoxic drugs-associated AKI. Many potential therapies and interventions are on the horizon, but most of the future research will need to focus more on a step-wise, protocoled, kidney-oriented approach, than on single treatments.
authors.affiliation: Emergency and Organ Transplantation Department - Anesthesia and Intensive Care Unit - University of Bari, Italy. nicola.brienza@uniba.it
authors.forename: Nicola
authors.initials: N
authors.lastname: Brienza
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Giglio
authors.forename: Lidia
authors.initials: L
authors.lastname: Dalfino
mesh_terms: D058186:Acute Kidney Injury / Q000517:prevention & control*; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D002985:Clinical Protocols; D003422:Critical Care; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units