Acute kidney injury in the critically ill: an updated review on pathophysiology and management

 

Acute kidney injury in the critically ill: an updated review on pathophysiology and management

By: Peter Pickkers, Michael Darmon, Eric Hoste, Michael Joannidis, Matthieu Legrand, Marlies Ostermann, John R. Prowle, Antoine Schneider & Miet Schetz 

Intensive Care Medicine volume 47, pages 835–850 Published: 02 July 2021

Abstract: Acute kidney injury (AKI) is now recognized as a heterogeneous syndrome that not only affects acute morbidity and mortality, but also a patient’s long-term prognosis. In this narrative review, an update on various aspects of AKI in critically ill patients will be provided. Focus will be on prediction and early detection of AKI (e.g., the role of biomarkers to identify high-risk patients and the use of machine learning to predict AKI), aspects of pathophysiology and progress in the recognition of different phenotypes of AKI, as well as an update on nephrotoxicity and organ cross-talk. In addition, prevention of AKI (focusing on fluid management, kidney perfusion pressure, and the choice of vasopressor) and supportive treatment of AKI is discussed. Finally, post-AKI risk of long-term sequelae including incident or progression of chronic kidney disease, cardiovascular events and mortality, will be addressed.

Take home message: Acute kidney injury (AKI) is recognized as an heterogeneous syndrome affecting short- and long-term morbidity and mortality. Progress on prediction and early detection, clinical phenotypes, pathophysiology, nephrotoxicity, organ cross-talk, prevention and supportive treatment of AKI as well as long-term sequelae are addressed in this review paper