Acute kidney injury following acute pancreatitis: A review

Abstract

Backround. Acute kidney injury (AKI) is a common serious complication of severe acute pancreatitis (SAP) and an important marker of morbidity and mortality in critically ill septic patients. AKI due to severe acute pancreatitis can be the result of hypoxemia, release of pancreatic amylase from the injured pancreas with impairment of renal microcirculation, decrease in renal perfusion pressure due to abdominal compartment syndrome, intraabdominal hypertension or hypovolemia. Endotoxins and reactive oxygen species (ROS) also play an important role in the pathophysiology of SAP and AKI. Knowledge of the pathophysiology and diagnosis of AKI following SAP might improve the therapeutic outcome of critically ill patients. Methods and Results. An overview of the pathophysiology, diagnosis and potential treatment options based on a literature search of clinical human and experimental studies from 1987 to 2013. Conclusions. Early recognition of AKI and SAP in order to prevent severe complication like septic shock, intraabdominal hypertension or abdominal compartment syndrome leading to multiple organ dysfunction syndrome is a crucial tool of therapeutic measures in intensive care.

Effect of acute kidney injury on mortality and hospital stay in patient with severe acute pancreatitis

“…Commonly associated with high morbidity and mortality, AKI is often secondary to extrarenal events and familiar multifactorial etiology . Severe acute pancreatitis (SAP), an acute abdominal disease with unpredictable clinical courses, is an important precursor of AKI and drastically increases the disease burden . For example, SAP leads to an incidence of AKI as high as 54% among critically ill patients .…”

Gastrointestinal Non-Infectious Complications in Patients on Peritoneal Dialysis

“…A significant complication of severe acute pancreatitis is acute renal failure (renal hypoperfusion, IAH: oliguria occurs when IAP ≥ 15 mmHg, and anuria occurs when IAP ≥ 30 mmHg). Fractional excretion of sodium (FE Na + ) ˃ 1%, the concentration of sodium in the urine sample (U Na + ) ˃ 40 mmol / l and fractional excretion of urea (FE of urea) ≥ 35% point to the development of acute tubular necrosis in patients with severe acute pancreatitis (5,7). Treatment of acute renal failure in patients with severe acute pancreatitis includes the treatment of acute pancreatitis, IAH, ACS, and dialysis support therapy (5,7).…”

“…Fractional excretion of sodium (FE Na + ) ˃ 1%, the concentration of sodium in the urine sample (U Na + ) ˃ 40 mmol / l and fractional excretion of urea (FE of urea) ≥ 35% point to the development of acute tubular necrosis in patients with severe acute pancreatitis (5,7). Treatment of acute renal failure in patients with severe acute pancreatitis includes the treatment of acute pancreatitis, IAH, ACS, and dialysis support therapy (5,7). Continuous veno-venous-hemofiltration (CVVHF) is used as a nonrenal indication for the reduction of a systemic inflammatory response.…”

“…Continuous veno-venous-hemofiltration (CVVHF) is used as a nonrenal indication for the reduction of a systemic inflammatory response. High-volume CVVHF (HVHF) is used in the early stages of acute pancreatitis (within 72 h), and the test results show that it substantially reduces the concentration of inflammatory cytokines in the serum (TNFα, IL-1, IL-2, IL-6) (5,7). With patients with severe acute pancreatitis, acute renal impairment and haemodynamic instability, continuous veno-venous haemodiafiltration (CVVHDF) is used (standard dose filtration rate: 20 ml/ kg/h, high dose of filtration: 35 ml/kg/h).…”

High Expression Levels of Trigger Receptor Expressed on Myeloid Cells-1 on Neutrophils Associated with Increased Severity of Acute Pancreatitis in Mice

“…During the pathogenic process of SAP, aberrant activation of inflammatory cells and excessive production of inflammatory mediators such as tumor necrosis factor (TNF)-α, interleukin (IL)-6, and granulocyte-macrophage colony stimulating factor (GM-CSF) can cause pancreatic necrosis and systemic inflammatory response syndrome (SIRS) and MODS, which are the leading causes of morbidity and mortality. 1,4,5) Other affected individuals may die within weeks or months due to severe complications and septicemia. 6) While early intervention of SAP patients may save their lives, there are few reliable biomarkers precisely to diagnose SAP at early stage.…”