Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment

被引:1023
作者
Peerapornratana, Sadudee [1 ,2 ,3 ,4 ]
Manrique-Caballero, Carlos L. [1 ,2 ]
Gomez, Hernando [1 ,2 ]
Kellum, John A. [1 ,2 ]
机构
[1] Univ Pittsburgh, Sch Med, Ctr Crit Care Nephrol, Dept Crit Care Med, 3347 Forbes Ave,Suite 220, Pittsburgh, PA 15213 USA
[2] Univ Pittsburgh, Sch Med, Dept Crit Care Med, Clin Res Invest & Syst Modeling Acute Illness Ctr, Pittsburgh, PA 15213 USA
[3] Chulalongkorn Univ, Fac Med, Excellence Ctr Crit Care Nephrol, Div Nephrol, Bangkok, Thailand
[4] Chulalongkorn Univ, Dept Lab Med, Bangkok, Thailand
基金
美国国家卫生研究院;
关键词
epidemiology; inflammation; metabolic reprogramming; microvascular dysfunction; prevention; sepsis-associated acute kidney injury; sepsis-induced acute kidney injury; treatment; RENAL-REPLACEMENT THERAPY; CRITICALLY-ILL PATIENTS; HIGH-VOLUME HEMOFILTRATION; POLYMYXIN-B HEMOPERFUSION; ORGAN BLOOD-FLOW; ALTERNATIVE RESUSCITATION STRATEGIES; GOAL-DIRECTED RESUSCITATION; HIGH-CUTOFF HEMOFILTERS; SEPTIC SHOCK PATIENTS; HYDROXYETHYL STARCH;
D O I
10.1016/j.kint.2019.05.026
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Sepsis-associated acute kidney injury (S-AKI) is a frequent complication of the critically ill patient and is associated with unacceptable morbidity and mortality. Prevention of S-AKI is difficult because by the time patients seek medical attention, most have already developed acute kidney injury. Thus, early recognition is crucial to provide supportive treatment and limit further insults. Current diagnostic criteria for acute kidney injury has limited early detection; however, novel biomarkers of kidney stress and damage have been recently validated for risk prediction and early diagnosis of acute kidney injury in the setting of sepsis. Recent evidence shows that microvascular dysfunction, inflammation, and metabolic reprogramming are 3 fundamental mechanisms that may play a role in the development of S-AKI. However, more mechanistic studies are needed to better understand the convoluted pathophysiology of S-AKI and to translate these findings into potential treatment strategies and add to the promising pharmacologic approaches being developed and tested in clinical trials.
引用
收藏
页码:1083 / 1099
页数:17
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