title: Acute kidney injury in sepsis.
abstract: Acute kidney injury (AKI) and sepsis carry consensus definitions. The simultaneous presence of both identifies septic AKI. Septic AKI is the most common AKI syndrome in ICU and accounts for approximately half of all such AKI. Its pathophysiology remains poorly understood, but animal models and lack of histological changes suggest that, at least initially, septic AKI may be a functional phenomenon with combined microvascular shunting and tubular cell stress. The diagnosis remains based on clinical assessment and measurement of urinary output and serum creatinine. However, multiple biomarkers and especially cell cycle arrest biomarkers are gaining acceptance. Prevention of septic AKI remains based on the treatment of sepsis and on early resuscitation. Such resuscitation relies on the judicious use of both fluids and vasoactive drugs. In particular, there is strong evidence that starch-containing fluids are nephrotoxic and decrease renal function and suggestive evidence that chloride-rich fluid may also adversely affect renal function. Vasoactive drugs have variable effects on renal function in septic AKI. At this time, norepinephrine is the dominant agent, but vasopressin may also have a role. Despite supportive therapies, renal function may be temporarily or completely lost. In such patients, renal replacement therapy (RRT) becomes necessary. The optimal intensity of this therapy has been established, while the timing of when to commence RRT is now a focus of investigation. If sepsis resolves, the majority of patients recover renal function. Yet, even a single episode of septic AKI is associated with increased subsequent risk of chronic kidney disease.
authors.affiliation: School of Medicine, The University of Melbourne, Melbourne, Australia. Rinaldo.bellomo@austin.org.au.|Department of Intensive Care, Austin Hospital, Heidelberg, VIC, 3084, Australia. Rinaldo.bellomo@austin.org.au.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.affiliation: Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.|International Renal Research Institute of Vicenza (IRRIV) San Bortolo Hospital, Vicenza, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
authors.affiliation: Division of Nephrology, St. Michael's Hospital and the University of Toronto, Toronto, Canada.|Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada.
authors.forename: Ron
authors.initials: R
authors.lastname: Wald
authors.affiliation: Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Martensson
authors.affiliation: Department of Intensive Care, Geelong University Hospital, Geelong, VIC, Australia.|Department of Intensive Care, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Maiden
authors.affiliation: Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia.|Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Glassford
authors.affiliation: Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia.
authors.forename: Yugeesh
authors.initials: Y
authors.lastname: Lankadeva
authors.affiliation: Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Suvi T
authors.initials: ST
authors.lastname: Vaara
authors.affiliation: Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: Antoine
authors.initials: A
authors.lastname: Schneider
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood*; D003422:Critical Care / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D017582:Renal Replacement Therapy / Q000379:methods*; D018805:Sepsis / Q000150:complications*
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: Acute kidney injury; Biomarkers; Creatinine; Recovery; Renal replacement therapy; Sepsis