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Critical Care
Published in: Critical Care 6/2013

01-12-2013 | Commentary

Acute kidney injury in sepsis: transient or intrinsic?

Author: Achim Jörres

Published in: Critical Care | Issue 6/2013

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Abstract

The negative prediction of intrinsic versus transient acute kidney injury (AKI) in septic patients may be facilitated by combined assessment of fractional excretion of sodium and urea. If both excretions are high this would signal the presence of transient AKI and suggest that successful restoration of diuresis by conservative therapy is likely, thus supporting a wait-and-watch approach regarding the initiation of acute renal replacement therapy.
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Oppert M, Engel C, Brunkhorst FM, Bogatsch H, Reinhart K, Frei U, Eckardt KU, Loeffler M, John S, German competence network sepsis (sepnet): : Acute renal failure in patients with severe sepsis and septic shock – a significant independent risk factor for mortality: results from the german prevalence study. Nephrol Dial Transplant 2008, 23: 904-909.CrossRefPubMed
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Coca SG, Singanamala S, Parikh CR: Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int 2012, 81: 442-448. 10.1038/ki.2011.379PubMedCentralCrossRefPubMed
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Bouchard J, Soroko SB, Chertow GM, Himmelfarb J, Ikizler TA, Paganini EP, Mehta RL, Program to improve care in acute renal disease (PICARD) study group:: Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int 2009, 76: 422-427. 10.1038/ki.2009.159CrossRefPubMed
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Vanmassenhove J, Glorieux G, Hoste E, Dhondt A, Van Biesen W: Urinary output and fractional excretion of sodium and urea as indicators of transient versus intrinsic acute kidney injury during early sepsis. Crit Care 2013, 17: R234. 10.1186/cc13057PubMedCentralCrossRefPubMed
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Myburgh JA, Finfer S, Bellomo R, Billot L, Cass A, Gattas D, Glass P, Lipman J, Liu B, McArthur C, McGuinness S, Rajbhandari D, Taylor CB, Webb SA, CHEST investigators; Australian and New Zealand intensive care society clinical trials group:: Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med 2012, 367: 1901-1911. 10.1056/NEJMoa1209759CrossRefPubMed
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Aregger F, Uehlinger DE, Witowski J, Brunisholz RA, Hunziker P, Frey FJ, Jörres A: Identification of IGFBP-7 by urinary proteomics as a novel prognostic marker in early acute kidney injury. Kidney Int 2013. [Epub ahead of print]
Metadata
Title
Acute kidney injury in sepsis: transient or intrinsic?
Author
Achim Jörres
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2013
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc13124

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