title: Acute kidney injury in cardiac surgery.
abstract: OBJECTIVE
  Acute kidney injury (AKI) is a long-recognized complication of cardiac surgery. It is a commonly encountered clinical syndrome that, in its most severe form, increases the odds of operative mortality three to eight-fold. The pathogenesis of cardiac surgery-associated acute kidney injury (CSA-AKI) is complex. No single intervention is likely to provide a panacea, and thus, the purpose of this review is to assess the wide breadth of emerging research into potential strategies to prevent, diagnose, and treat CSA-AKI.
  
  
  RESULTS
  Research in the field of CSA-AKI published within the last 18 months adds further layers of knowledge to many previously studied areas. These include its definition (Risk, Injury, Failure, Loss, End-stage kidney disease, Acute Kidney Injury Network, and Kidney Disease: Improving Global Outcomes criteria), diagnosis (biomarkers and intraoperative renal oximetry), prevention (statin therapy, acetylsalicylic acid, N-acetylcysteine, sodium bicarbonate, off-pump coronary revascularization, goal-directed hemodynamic therapy, and minimizing blood transfusion), and treatment (early initiation of renal replacement therapy).
  
  
  CONCLUSIONS
  Although there has been much high-quality research conducted in this field in recent years, preventing CSA-AKI by avoiding renal insults remains the mainstay of management. Although biomarkers have the potential to diagnose CSA-AKI at an earlier stage, efficacious interventions to treat established CSA-AKI remain elusive.
authors.affiliation: Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, USA.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Gaffney
authors.forename: Robert N
authors.initials: RN
authors.lastname: Sladen
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D017582:Renal Replacement Therapy