ACUTE KIDNEY INJURY DURING CRITICAL ILLNESS – A GLOBAL CHALLENGE

M Ostermann

doi:10.21292/2078-5658-2019-16-2-83-95

Abstract

The report is devoted to the problem of acute kidney injury (AKI) in critically ill patients. Currently, the clinical definition of AKI is based on the assessment of increasing serum creatinine, but this method has a number of significant drawbacks. Perhaps the use of biomarkers for early detection of renal injury will improve diagnostic results. Up to date, no specific drug therapy for AKI has no available. The therapeutic tactics are based on the assessment of the risk of development AKI in critically ill patient, hemodynamic optimization, revision of drug therapy to exclude nephrotoxic drugs and the use of renal replacement therapy (RRT). Despite the numerous studies and the presence of multiple researches of AKI, there are many unclear issues related, for example, how to choose tactics of infusion therapy, the use of vasopressor support in patients with AKI, the time of the beginning and the choice of the mode of RRT, the feasibility of combining several technologies of extracorporeal hemocorrection. It is important to define how to improve the short-term prognosis and the long-term consequences of renal dysfunction.

Highlights

Acute kidney injury (AKI) is a frequent complication of critical illness
The definition of AKI has evolved from the Risk, Injury, Failure, Loss, End-stage (RIFLE) criteria in 2004 to the AKI Network (AKIN) classification in 2007
In 2012, both were merged resulting in the Kidney Disease Improving Global Outcomes (KDIGO) classification [17]

Summary

Introduction

Acute kidney injury (AKI) is a frequent complication of critical illness. It is usually multifactorial but the most common causes are sepsis, volume depletion, haemodynamic instability and nephrotoxic exposures. A.Bourgoin et al [6] compared two different MAP goals (65 mmHg and 85 mmHg) in 28 patients with septic shock and found that an increased MAP was not associated with any changes in renal function variables, including urine flow, serum creatinine, or creatinine clearance. Renal replacement therapy (RRT) is considered a supportive therapy in AKI in situations where the metabolic and fluid demands exceed native kidney function. Advances in technologies have provided opportunities to combine RRT with different forms of extracorporeal organ support (ECOS) according to the needs of the patient, including extracorporeal CO2 removal (ECCO2R), veno-arterial (VA) or VV extracorporeal membrane oxygenation (ECMO), ventricular assist device, liver support systems and various blood purification devices [15]. Further progress in technologies is expected with the development of integrated advanced multi-organ support platform allowing the provision of extracorporeal support for individual organs according to the needs of the patient [7]

Conclusions

17. Kidney Disease