title: Sepsis-associated acute kidney injury.
abstract: Acute kidney injury (AKI) is an epidemic problem. Sepsis has long been recognized as a foremost precipitant of AKI. Sepsis-associated AKI (SA-AKI) portends a high burden of morbidity and mortality in both children and adults with critical illness. Although our understanding of its pathophysiology is incomplete, SA-AKI likely represents a distinct subset of AKI contributed to by a unique constellation of hemodynamic, inflammatory, and immune mechanisms. SA-AKI poses significant clinical challenges for clinicians. To date, no singular effective therapy has been developed to alter the natural history of SA-AKI. Rather, current strategies to alleviate poor outcomes focus on clinical risk identification, early detection of injury, modifying clinician behavior to avoid harm, early appropriate antimicrobial therapy, and surveillance among survivors for the longer-term sequelae of kidney damage. Recent evidence has confirmed that patients no longer die with AKI, but from AKI. To improve the care and outcomes for sufferers of SA-AKI, clinicians need a robust appreciation for its epidemiology and current best-evidence strategies for prevention and treatment.
authors: Department of Pediatrics, Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors: Rashid
authors: R
authors: Alobaidi
authors: Center for Acute Care Nephrology, Cincinnati Children's Hospital and Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio.
authors: Rajit K
authors: RK
authors: Basu
authors: Center for Acute Care Nephrology, Cincinnati Children's Hospital and Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio. Electronic address: stuart.goldstein@cchmc.org.
authors: Stuart L
authors: SL
authors: Goldstein
authors: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors: Sean M
authors: SM
authors: Bagshaw
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000276:immunology / Q000378:metabolism; D000368:Aged; D002648:Child; D006801:Humans; D000860:Hypoxia / Q000378:metabolism; D007249:Inflammation; D017063:Outcome Assessment, Health Care; D018384:Oxidative Stress; D018570:Risk Assessment; D018805:Sepsis / Q000150:complications*
keywords: acute kidney injury; critical care nephrology; outcomes; sepsis