Abstract
Sepsis is life-threatening organ dysfunction resulting from a dysregulated host response to infection. It is one of the commonest causes of acute kidney injury (AKI) and is associated with an increase in both morbidity and mortality. Both haemodynamic and non-haemodynamic factors are involved in the pathogenesis of AKI in sepsis. Newer tests are available for the early diagnosis of AKI in septic patients and may provide an opportunity for prevention. The current mainstay of prevention is adequate fluid resuscitation and maintenance of systemic blood pressure, noradrenaline being the vasopressor of choice. Renal replacement therapy may improve outcomes. Continuous renal replacement modalities are preferred in those who are haemodynamically unstable. There is no consensus on the optimal timing or dose of renal replacement therapy.
Highlights
Sepsis has recently been redefined as life-threatening organ dysfunction resulting from a dysregulated host response to infection [1]
Drugs to avoid in acute kidney injury (AKI) include angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), non-steroidal anti-inflammatory drugs (NSAIDs), and radiocontrast
The Acute Renal Failure Trial Network (ARFTN) study demonstrated that there is no benefit of intermittent haemodialysis six times a week vs three times a week or continuous venovenous haemodiafiltration (CVVHDF) at a dose of 35 ml/kg/h vs 20 ml/kg/h [26]
Summary
Sepsis has recently been redefined as life-threatening organ dysfunction resulting from a dysregulated host response to infection [1]. Renal dysfunction may be seen in up to 16-67% of patients with sepsis [2]. This manifests as acute kidney injury (AKI), and is diagnosed based on a rise in serum creatinine and/or a reduction in urine output within a short period of time [3]. Sepsis is one of the commonest causes of AKI, and accounts for 26-60% of AKI seen in developed nations [2]. The occurrence of AKI in a patient with sepsis is a bad prognostic factor and is associated with increases in patient morbidity and mortality, as well as in health care costs [4]
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