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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

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01-11-2010 | Review Article/Brief Review

Review article: Acute kidney injury in critical illness

Authors: Sean M. Bagshaw, MD, Rinaldo Bellomo, MD, Prasad Devarajan, MD, Curtis Johnson, MD, C. J. Karvellas, MD, D. James Kutsiogiannis, MD, Ravindra Mehta, MD, Neesh Pannu, MD, Adam Romanovsky, MD, Geoffrey Sheinfeld, MD, Samantha Taylor, MN, Michael Zappitelli, MD, R. T. Noel Gibney, MD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 11/2010

Abstract

Purpose

This review provides a focused and comprehensive update on emerging evidence related to acute kidney injury (AKI).

Principal findings

Acute kidney injury is a significant clinical problem that increasingly complicates the course of hospitalization and portends worse clinical outcome for sick hospitalized patients. The recent introduction of consensus criteria for the diagnosis of AKI (i.e., RIFLE/AKIN classification) have greatly improved our capacity not only to standardize the diagnosis and classification of severity of AKI, but also to facilitate conducting comparative epidemiologic studies in an effort to better understand the burden of adult and pediatric AKI and its syndromes (i.e., septic, cardio-renal, hepato-renal). The characterization of several novel AKI-specific biomarkers (i.e., neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and interleukin-18) is extending our understanding of the pathophysiology of AKI. Moreover, these biomarkers appear to have clinical relevance for early detection and they provide prognostic value. These innovations are aiding in the design of epidemiologic surveys and randomized trials of therapeutic interventions. Strategies for prevention and conservative management of AKI across a range of clinical settings are discussed, including sepsis, hepato-renal syndrome, cardio-renal syndrome, rhabdomyolysis and in the perioperative setting.

Conclusions

Acute kidney injury is an escalating clinical problem in hospitalized patients. Recent advances in AKI have improved knowledge of its pathogenesis, diagnosis, and prognosis; however, considerable research effort is needed. There are still relatively few interventions proven to alter the natural history of established AKI in hospitalized settings, and its development foretells less favourable outcomes.

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Title: Review article: Acute kidney injury in critical illness
Authors: Sean M. Bagshaw, MD
Rinaldo Bellomo, MD
Prasad Devarajan, MD
Curtis Johnson, MD
C. J. Karvellas, MD
D. James Kutsiogiannis, MD
Ravindra Mehta, MD
Neesh Pannu, MD
Adam Romanovsky, MD
Geoffrey Sheinfeld, MD
Samantha Taylor, MN
Michael Zappitelli, MD
R. T. Noel Gibney, MD
Publication date: 01-11-2010
Publisher: Springer-Verlag
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 11/2010
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-010-9375-4

At a glance: The STEP trials

Springer Medicine

Review article: Acute kidney injury in critical illness

Abstract

Purpose

Principal findings

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Principal findings

Conclusions

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