Abstract
role of AKI in the ICU is contributed to its association with high mortality, morbidity and economic costs. It develops as a result of the reductions in renal blood flow (RBF), cellular and humoural immune system response to infection, nephrotoxic drugs and cellular injury 1–3 . One important controversy area in the field of AKI is the pathogenesis of AKI. The classification of AKI into prerenal and renal may be questionable today. The pre-renal state is very transient and mild, but when it becomes severe, prolonged and with already compromised kidney, the pre-renal state can lead to renal AKI. In addition, the fact that acute tubular necrosis (ATN) is the main pathological character of AKI seems to be challenged by the recent findings that renal blood flow may not be reduced, at least in sepsis, and other types of cell damage may occur 4 . The early identification of at-risk patients and prevention of acute kidney injury to reduce mortality rate (50%–70%) associated with acute kidney injury in sepsis is essentially required 5 . However, failure of AKI preventive strategies is contributed to the lack of real-time sensitive and specific renal biomarkers and diagnostic tool, which allow the early detection of AKI. One of the research priority today is to find a tool or marker for an early prediction of AKI, to prevent or attenuate persistent AKI in patients with transient AKI 6 . The aims of this review are to discuss briefly recent advance in understanding the pathological changes in sepsis-induced AKI, and the current investigated tools and biomarkers with their advantages and limitations in field of AKI.
Highlights
Acute kidney injury (AKI), the most common part of the multiple organ dysfunction syndrome, is the most frequent cause of death in septic patients admitted to intensive care units
The fact that acute tubular necrosis (ATN) is the main pathological character of AKI seems to be challenged by the recent findings that renal blood flow may not be reduced, at least in sepsis, and other types of cell damage may occur[4]
While pre-renal AKI is not associated with histopathological renal injury, acute tubular necrosis is associated with reduced renal blood flow
Summary
Acute kidney injury (AKI), the most common part of the multiple organ dysfunction syndrome, is the most frequent cause of death in septic patients admitted to intensive care units. The pathogenesis of sepsisinduced AKI is a controversy area. Multiple organ dysfunction syndrome is the most frequent cause of death in septic patients admitted to intensive care units. Recently termed acute kidney injury (AKI), is the most common part of the multiple organ dysfunction syndrome. One important controversy area in the field of AKI is the pathogenesis of AKI. The fact that acute tubular necrosis (ATN) is the main pathological character of AKI seems to be challenged by the recent findings that renal blood flow may not be reduced, at least in sepsis, and other types of cell damage may occur[4]
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