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The implications and management of septic acute kidney injury

Nature Reviews Nephrology volume 7, pages 218–225 (2011)Cite this article

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Abstract

Sepsis is the most common and severe cause of morbidity and mortality among critically ill patients. Multiple organ dysfunction syndrome often complicates sepsis, leading to a worse prognosis that is proportional to the severity and number of damaged organs. Acute kidney injury (AKI) also complicates sepsis, with a linear relationship between the severity of kidney damage and sepsis prognosis. The management of sepsis and septic AKI involves intensive proactive preventive measures, medical and extracorporeal treatment of established sepsis, support of failing organs and rehabilitation of the residual effects left by this devastating syndrome. Unfortunately, although some innovations in the clinical management of sepsis are now available, their beneficial effects on renal function are still uncertain. The aim of this Review is to provide an update on the current state of interventions in sepsis-related AKI. Prevention, pharmacological support and extracorporeal blood purification for septic AKI will be reviewed and discussed.

Key Points

  • Sepsis has a complex pathophysiology and typically causes multiple organ dysfunction

  • Sepsis-related acute kidney injury (AKI) is an independent risk factor for mortality

  • Potential medical interventions in sepsis-related AKI have not yet been adequately validated in routine clinical practice

  • Current recommendations are that adequate resuscitation by early goal-directed therapy should be provided together with pharmacological support (vasopressor and diuretics), avoiding fluid overload

  • In patients with severe septic AKI, extracorporeal blood purification should be provided in order to support renal function and to manage fluid overload; optimal timing of renal replacement therapy has not yet been defined

  • The currently recommended dose for continuous renal replacement therapies is 25 ml/kg/h, and higher doses have not been associated with improved survival; however, such therapies should be carefully monitored and underdosing avoided

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Author information

Authors and Affiliations

  1. Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy

    Zaccaria Ricci & Angelo Polito

  2. Medical Intensive Care Unit, Raymond Poincaré Teaching Hospital, 104 Boulevard Raymond Poincaré, 92380, Garches, France

    Andrea Polito

  3. Department of Nephrology, St. Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy

    Claudio Ronco

Authors
  1. Zaccaria Ricci
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  2. Andrea Polito
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  3. Angelo Polito
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  4. Claudio Ronco
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Contributions

Z. Ricci, Angelo Polito and Andrea Polito researched data for this article. C. Ronco and Andrea Polito made a substantial contribution to discussion of the content. Z. Ricci and Angelo Polito wrote the article, and C. Ronco reviewed/edited the manuscript before submission.

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Correspondence to Claudio Ronco.

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The authors declare no competing financial interests.

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Ricci, Z., Polito, A., Polito, A. et al. The implications and management of septic acute kidney injury. Nat Rev Nephrol 7, 218–225 (2011). https://doi.org/10.1038/nrneph.2011.15

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