Severe Infection, Sepsis and Acute Kidney Injury

Vandijck, Dominique; Reynvoet, Emmelie; Blot, Stijn; Vandecasteele, Els; Hoste, Eric A. J.

doi:10.1179/acb.2007.075

Cited by 36 publications

(20 citation statements)

References 45 publications

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“…AKI has secondary pathophysiological effects, for example, increased risk of infection [33], contribution to the development of multiorgan dysfunction syndrome [34], and altered hepatic drug metabolism [35]. Volume overload and acid-base derangements typical of renal dysfunction have serious consequences in the duration and weaning of mechanical ventilation [36].…”

Section: Discussionmentioning

confidence: 99%

Estimated Glomerular Filtration Rate Correlates Poorly with Four-Hour Creatinine Clearance in Critically Ill Patients with Acute Kidney Injury

Kirwan

Philips

MacPhee

2013

Critical Care Research and Practice

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Introduction. RIFLE and AKIN provide a standardised classification of acute kidney injury (AKI), but their categorical rather than continuous nature restricts their use to a research tool. A more accurate real-time description of renal function in AKI is needed, and some published data suggest that equations based on serum creatinine that estimate glomerular filtration rate (eGFR) can provide this. In addition, incorporating serum cystatin C concentration into estimates of GFR may improve their accuracy, but no eGFR equations are validated in critically ill patients with AKI. Aim. This study tests whether creatinine or cystatin-C-based eGFR equations, used in patients with CKD, offer an accurate representation of 4-hour creatinine clearance (4CrCl) in critically ill patients with AKI. Methods. Fifty-one critically ill patients with AKI were recruited. Thirty-seven met inclusion criteria, and the performance of eGFR equations was compared to 4CrCl. Results. eGFR equations were better than creatinine alone at predicting 4CrCl. Adding cystatin C to estimates did not improve the bias or add accuracy. The MDRD 7 eGFR had the best combination of correlation, bias, percentage error and accuracy. None were near acceptable standards quoted in patients with chronic kidney disease (CKD). Conclusions. eGFR equations are not sufficiently accurate for use in critically ill patients with AKI. Incorporating serum cystatin C does not improve estimates. eGFR should not be used to describe renal function in patients with AKI. Standards of accuracy for validating eGFR need to be set.

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Section: Discussionmentioning

confidence: 99%

Estimated Glomerular Filtration Rate Correlates Poorly with Four-Hour Creatinine Clearance in Critically Ill Patients with Acute Kidney Injury

Kirwan

Philips

MacPhee

2013

Critical Care Research and Practice

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“…Sepsis causes AKI in up to 50% of cases (19,20). Although the precise mechanism remains unclear, a gamut of cytokines is implicated, as are circulating lymphocytes, T cells, and native kidney tubular epithelial and endothelial cells.…”

Section: Methodsmentioning

confidence: 98%

An update and review of acute kidney injury in pediatrics

Basu

Devarajan

Wong

et al. 2011

Pediatric Critical Care Medicine

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There is limited data-driven evidence in pediatrics regarding effective therapy for acute kidney injury, a significant problem in the pediatric intensive care unit extending length of stay, ventilator days, and overall mortality. Sublethal kidney injury may be contributing to overall morbidity. We conclude that prospective clinical trials are needed to evaluate specific diagnostic aids, such as biomarkers, and therapeutic strategies, such as early initiation of continuous renal replacement therapy in children with fluid overload.

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“…Sepsis is defined as the excessive inflammatory reaction of an organism to an infection [1, 2]. It is not a disease in itself, but rather is a systemic inflammatory response due to infection, burn, trauma, or other factors [3].…”

Section: Introductionmentioning

confidence: 99%

Septic Encephalopathy

Ziaja

2013

Curr Neurol Neurosci Rep

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Every year, more cases of sepsis appear in intensive care units. The most frequent complication of sepsis is septic encephalopathy (SE), which is also the essential determinant of mortality. Despite many years of research, it still is not known at which stage of sepsis the first signs of SE appear; however, it is considered the most frequent form of encephalopathy. Patients have dysfunction of cognitive abilities and consciousness, and sometimes even epileptic seizures. Despite intensive treatment, the effects of SE remain for many years and constitute an important social problem. Numerous studies indicate that changes in the brain involve free radicals, nitric oxide, increased synthesis of inflammatory factors, disturbances in cerebral circulation, microthromboses, and ischemia, which cause considerable neuronal destruction in different areas of the brain. To determine at what point during sepsis the first signs of SE appear, different experimental models are needed to detect the aforementioned changes and to select the proper therapy for this syndrome.

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Severe Infection, Sepsis and Acute Kidney Injury

Cited by 36 publications

References 45 publications

Estimated Glomerular Filtration Rate Correlates Poorly with Four-Hour Creatinine Clearance in Critically Ill Patients with Acute Kidney Injury

Estimated Glomerular Filtration Rate Correlates Poorly with Four-Hour Creatinine Clearance in Critically Ill Patients with Acute Kidney Injury

An update and review of acute kidney injury in pediatrics

Septic Encephalopathy

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