Review article: Acute kidney injury in critical illness

Abstract

Purpose This review provides a focused and comprehensive update on emerging evidence related to acute kidney injury (AKI).Principal findings Acute kidney injury is a significant clinical problem that increasingly complicates the course of hospitalization and portends worse clinical outcome for sick hospitalized patients. The recent introduction of consensus criteria for the diagnosis of AKI (i.e., RIFLE/AKIN classification) have greatly improved our capacity not only to standardize the diagnosis and classification of severity of AKI, but also to facilitate conducting comparative epidemiologic studies in an effort to better understand the burden of adult and pediatric AKI and its syndromes (i.e., septic, cardio-renal, hepato-renal). The characterization of several novel AKI-specific biomarkers (i.e., neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and interleukin-18) is extending our understanding of the pathophysiology of AKI. Moreover, these biomarkers appear to have clinical relevance for early detection and they provide prognostic value. These innovations are aiding in the design of epidemiologic surveys and randomized trials of therapeutic interventions. Strategies for prevention Editor's Note: This article is the first of two linked special review articles published in this issue of the Journal. The concept of these articles emerged from the scientific content of the 2010 Acute Kidney Injury (AKI) and Renal Support in Critical Illness Symposium, hosted in Edmonton, Alberta. This review (Part 1) provides a focused and comprehensive update on emerging evidence in the diagnosis and classification of AKI, on specific AKI syndromes, and on the prevention and conservative management of hospitalized patients with AKI. Abstracts presented at this meeting were selected on the basis of peer review by the Scientific Committee and were accepted for presentation at the AKI 2010 Symposium, and appear as Electronic Supplementary Material at

Selenium Inhibits Renal Oxidation and Inflammation But Not Acute Kidney Injury in an Animal Model of Rhabdomyolysis

“…Urinary clusterin, a marker for AKI that correlates with hypoxic tubular damage (28), and kidney injury molecule-1 (KIM-1), a glycoprotein released in the event of early proximal tubule injury (6,59,61), both increased significantly after RM ( Fig. 2A and 2B).…”

Spectrum of Acute Kidney Injury and its Outcome in Intensive Care Unit in Tertiary Care Center in India

“…In particular, there has been a transition in patient demographics such that patients are older and have a greater burden of comorbid disease. These patients are more likely developing AKI in the context of multiple organ failure (7). The commonest cause of AKI in the present study was sepsis related AKI (35%) followed by malaria (14%) and gastrointestinal problems (13%) such as diarrhea; persistent vomiting and upper GI bleed.…”

“…However, a prospective randomized study in a mixed ICU population found no difference in survival between early (on average within 7 hours of development of AKI) and late (on average 42 hours There is a strong relationship between severity of AKI and mortality (4). Indeed, even after adjustment for relevant covariates, several epidemiologic studies have shown the presence and severity of AKI to independently portend higher risk of death (7). A number of epidemiologic studies have tried to quantify the performance of the RIFLE classification with receiver operator characteristic curves (21,22).…”

The impact of hyperglycemia and obesity on hospitalization costs and clinical outcome in general surgery patients

“…Complications included a composite of major cardiovascular events, pneumonia, bacteremia, acute kidney injury (AKI), wound infection, and in-hospital mortality. ICD-9 codes were used to determining the presence of complications for all of these except for acute kidney injury, which was defined as an increase in serum creatinine greater than 50% from the patient's baseline admission creatinine (Bagshaw et al, 2010).…”