title: Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies).
abstract: Acute kidney injury (AKI) is a syndrome that has progressed a great deal over the last 20 years. The decrease in urine output and the increase in classical renal biomarkers, such as blood urea nitrogen and serum creatinine, have largely been used as surrogate markers for decreased glomerular filtration rate (GFR), which defines AKI. However, using such markers of GFR as criteria for diagnosing AKI has several limits including the difficult diagnosis of non-organic AKI, also called "functional renal insufficiency" or "pre-renal insufficiency". This situation is characterized by an oliguria and an increase in creatininemia as a consequence of a reduction in renal blood flow related to systemic haemodynamic abnormalities. In this situation, "renal insufficiency" seems rather inappropriate as kidney function is not impaired. On the contrary, the kidney delivers an appropriate response aiming to recover optimal systemic physiological haemodynamic conditions. Considering the kidney as insufficient is erroneous because this suggests that it does not work correctly, whereas the opposite is occurring, because the kidney is healthy even in a threatening situation. With current definitions of AKI, normalization of volaemia is needed before defining AKI in order to avoid this pitfall.
authors.affiliation: Service de Réanimation Polyvalente, IRCAN (Inserm U1081, CNRS UMR7284 et CHU de Nice, Hôpital Pasteur 2, 30 Voie Romaine, CHU de Nice, 06000, Nice, France. ichai@unice.fr.
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authors.affiliation: Service de Réanimation, Hôpital Marc Jacquet, 77000, Melun, France. Christophe.Vinsonneau@ch-melun.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Vinsonneau
authors.affiliation: Service de Réanimation Polyvalente, CHU de Nice, 30 Voie Romaine, 06000, Nice, France.
authors.forename: Bertrand
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authors.lastname: Souweine
authors.affiliation: Service de Réanimation médicale, CHU de Clermont-Ferrand, 63000, Clermont-Ferrand, France.
authors.forename: Fabien
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authors.lastname: Armando
authors.affiliation: Service de Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France.
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authors.affiliation: Service de Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital d'Avicenne, 125 rue de Stalingrad, 93000, Bobigny, France.
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authors.affiliation: Département de Médecine périopératoire, Hôpital Estaing, CHU de Clermont-Ferrand, 1 place Louis Aubrac, 63000, Clermont-Ferrand, France.
authors.forename: Jean-Michel
authors.initials: JM
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authors.affiliation: Service de réanimation, hôpital de la Charité, CHU de Saint-Etienne, 44 rue Pointe Cadet, 42100, Saint-Etienne, France.
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authors.forename: Jacques
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authors.affiliation: Service de Pédiatrie, hôpital Sud, CHU de Rennes, 16 Bd Bulgarie, 35203, Rennes, France.
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authors.lastname: Gaillot
authors.affiliation: Service de Pédiatrie, Néphrologie, hôpital des Enfants, CHU de Toulouse, 330 avenue de Grande-Bretagne, 31059, Toulouse Cedex, France.
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authors.affiliation: Service d'anesthésie-réanimation, Assistance Publique-Hôpitaux de Paris, hôpital Saint-Louis, 1, Avenue Claude-Vellefaux, 75010, Paris, France.
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authors.affiliation: Service de néphrologie-dialyse, hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, Place d'Arsonval, 69003, Lyon, France.
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authors.lastname: Tamion
authors.affiliation: Service de Réanimation Polyvalente, CHU de Nice, 30 Voie Romaine, 06000, Nice, France.
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