Septic versus non-septic acute kidney injury in critically ill patients: characteristics and clinical outcomes

Cruz, Marília Galvão; Dantas, João Gabriel Athayde de Oliveira; Levi, Talita Machado; Rocha, Mário de Seixas; Souza, Samilly Evangelista; Boa‐Sorte, Ney; Moura, Carlos Geraldo; Cruz, Constança Margarida Sampaio

doi:10.5935/0103-507x.20140059

Cited by 32 publications

(40 citation statements)

References 38 publications

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“…18 Despite more patients with septic AKI required RRT when compared with non-septic AKI, they had better renal recovery. This finding is actually similar to that reported by Cruz et al and Bagshaw et al, 8,19 signifying a difference in the pathophysiology [20][21][22] between septic and non-septic AKI. Instead, Singer et al proposed the cell cycle arrest hypothesis and mentioned that multiorgan failure induced by critical illness is primary a functional, rather than structural abnormality.…”

Section: Discussionsupporting

confidence: 81%

Septic acute kidney injury in critically ill patients – a single-center study on its incidence, clinical characteristics, and outcome predictors

et al. 2016

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Purpose The objective of this study is to examine the incidence, clinical characteristics, and outcome (90-day mortality) of critically ill Chinese patients with septic AKI. Methods Patients admitted to the ICU of a regional hospital from 1 January 2011 to 31 December 2013 were included, excluding those on chronic renal replacement therapy. AKI was defined using KDIGO criteria. Patients were followed till 90 days from ICU admission or death, whichever occurred earlier. Demographics, diagnosis, clinical characteristics, and outcome were analyzed. Results In total, 3687 patients were included and 54.7% patients developed AKI. Sepsis was the most common cause of AKI (49.2%). Compared to those without AKI, AKI patients had higher disease severity, more physiological and biochemical disturbance, and carried significant co-morbidities. Ninety-day mortality increased with severity of AKI (16.7, 27.5, and 48.3% for KDIGO stage 1, 2, and 3 AKI, p < 0.001). Full renal recovery was achieved in 71.6% of AKI patients. Compared with non-septic AKI, septic AKI was associated with higher disease severity and required more aggressive support. Non-recovery of renal function occurred in 2.5% of patients with septic AKI, compared with 6.4% in non-septic AKI (p < 0.001). Cox regression analysis showed that age, emergency ICU admission, post-operative cases, admission diagnosis, etiology of AKI, disease severity score, mechanical ventilation, vasopressor support, and blood parameters (like albumin, potassium and pH) independently predicted 90-day mortality. Conclusions AKI, especially septic AKI is common in critically ill Chinese patients and is associated with poor patient outcome. Etiology of AKI has a significant impact on 90-day mortality and may affect renal outcome. ARTICLE HISTORY

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Section: Discussionsupporting

confidence: 81%

Septic acute kidney injury in critically ill patients – a single-center study on its incidence, clinical characteristics, and outcome predictors

et al. 2016

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“…, Zang & Yan , Cruz et al . ). Renal failure in sepsis is characterized by decreased GFR, often estimated by increased plasma creatinine, and oliguria/anuria (Angus & van der Poll ).…”

Section: Sepsis and Akimentioning

confidence: 97%

“…Sepsis is the most common cause of AKI in intensive care units, and in combination, sepsis and severe renal dysfunction constitute a major risk of dying (50-65% 90-day mortality) (Bagshaw et al 2007, Zang & Yan 2013, Cruz et al 2014. Renal failure in sepsis is characterized by decreased GFR, often estimated by increased plasma creatinine, and oliguria/ anuria (Angus & van der Poll 2013).…”

Section: Sepsis and Akimentioning

confidence: 99%

Physiological aspects of Toll‐like receptor 4 activation in sepsis‐induced acute kidney injury

2016

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Sepsis‐induced acute kidney injury (SI‐AKI) is common and associated with high mortality. Survivors are at increased risk of chronic kidney disease. The precise mechanism underlying SI‐AKI is unknown, and no curative treatment exists. Toll‐like receptor 4 (TLR4) activates the innate immune system in response to exogenous microbial products. The result is an inflammatory reaction aimed at clearing a potential infection. However, the consequence may also be organ dysfunction as the immune response can cause collateral damage to host tissue. The purpose of this review is to describe the basis for how ligand binding to TLR4 has the potential to cause renal dysfunction and the mechanisms by which this may take place in gram‐negative sepsis. In addition, we highlight areas for future research that can further our knowledge of the pathogenesis of SI‐AKI in relation to TLR4 activation. TLR4 is expressed in the kidney. Activation of TLR4 causes cytokine and chemokine release as well as renal leucocyte infiltration. It also results in endothelial and tubular dysfunction in addition to altered renal metabolism and circulation. From a physiological standpoint, inhibiting TLR4 in large animal experimental SI‐AKI significantly improves renal function. Thus, current evidence indicates that TLR4 has the ability to mediate SI‐AKI by a number of mechanisms. The strong experimental evidence supporting a role of TLR4 in the pathogenesis of SI‐AKI in combination with the availability of pharmacological tools to target TLR4 warrants future human studies.

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“…Similar finding noticed by Marilla et al that sepsis is independent predictor of death. 22 In our study, requirement of mechanical ventilation was found to be an independent predictor of mortality in critically ill children admitted in PICU with AKI. Though MODS, requirement of renal replacement therapy and metabolic acidosis predicted mortality on univariate analysis, they were eliminated on multivariate logistic regression analysis.…”

Section: Discussionmentioning

confidence: 47%

Profile and outcome of acute kidney injury in critically ill children admitted to pediatric intensive care unit

Chauhan¹,

Phirke²,

Golhar³

et al. 2018

Int J Contemp Pediatr

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Background: Acute kidney injury (AKI) is defined as an abrupt onset of renal dysfunction resulting from injurious endogenous or exogenous processes characterized by a decrease in glomerular filtration rate (GFR) and an increase in serum creatinine. AKI is common in critically ill children and early diagnosis is important for better outcome in these children.Methods: This was a prospective observational study. Critically ill infants and children of either sex and in age group between >28 days to 12 years admitted to pediatric intensive care unit (PICU) were included. Serum creatinine and estimated creatinine clearance (eCC) were used to and patients classified as AKI on pRIFLE criteria either at admission or subsequently during the hospital stay. AKI cases were further classified into risk, injury or failure category on the day of development of AKI and the maximum pRIFLE stage reached during PICU stay was noted. Detailed data regarding the treatment received and use of nephrotoxic drugs, inotropic support, mechanical ventilation, dialysis and total length of stay in PICU in all was noted. Outcome of the subjects were observed for survival or mortality.Results: Total 343 subjects were enrolled in the study. During the study 27.1% patients developed AKI according to pRIFLE staging. In AKI category 60.21% reached maximum risk category, 21.5% reached maximum injury category, 18.28% reached maximum failure category. Amongst AKI subjects 64.52% had infectious etiology. Multiorgan dysfunction, encephalopathy, shock, metabolic acidosis, hypertension, mechanical ventilation and nephrotoxic drugs administration were more associated with AKI and was statistically significant.Conclusions: Pediatric modification of RIFLE criteria is sensitive index to detect AKI at earliest in critically ill children for early intervention leading to better outcome.

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Septic versus non-septic acute kidney injury in critically ill patients: characteristics and clinical outcomes

Cited by 32 publications

References 38 publications

Septic acute kidney injury in critically ill patients – a single-center study on its incidence, clinical characteristics, and outcome predictors

Septic acute kidney injury in critically ill patients – a single-center study on its incidence, clinical characteristics, and outcome predictors

Physiological aspects of Toll‐like receptor 4 activation in sepsis‐induced acute kidney injury

Profile and outcome of acute kidney injury in critically ill children admitted to pediatric intensive care unit

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