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Int. J. Mol. Sci. 2017, 18(7), 1387; doi:10.3390/ijms18071387

Issues of Acute Kidney Injury Staging and Management in Sepsis and Critical Illness: A Narrative Review

1
Department of Nephrology, Heidelberg University Hospital, 162, Im Neuenheimer Feld, D-69120 Heidelberg, Germany
2
Department of Anesthesiology, Heidelberg University Hospital, 110, Im Neuenheimer Feld, D-69120 Heidelberg, Germany
*
Author to whom correspondence should be addressed.
Received: 7 June 2017 / Revised: 24 June 2017 / Accepted: 24 June 2017 / Published: 28 June 2017
(This article belongs to the Special Issue Sepsis)
View Full-Text   |   Download PDF [1126 KB, uploaded 29 June 2017]   |  

Abstract

Acute kidney injury (AKI) has a high incidence on intensive care units around the world and is a major complication in critically ill patients suffering from sepsis or septic shock. The short- and long-term complications are thereby devastating and impair the quality of life. Especially in terms of AKI staging, the determination of kidney function and the timing of dialytic AKI management outside of life-threatening indications are ongoing matters of debate. Despite several studies, a major problem remains in distinguishing between beneficial and unnecessary “early” or even harmful renal replacement therapy (RRT). The latter might prolong disease course and renal recovery. AKI scores, however, provide an insufficient outcome-predicting ability and the related estimation of kidney function via serum creatinine or blood urea nitrogen (BUN)/urea is not reliable in AKI and critical illness. Kidney independent alterations of creatinine- and BUN/urea-levels further complicate the situation. This review critically assesses the current AKI staging, issues and pitfalls of the determination of kidney function and RRT timing, as well as the potential harm reflected by unnecessary RRT. A better understanding is mandatory to improve future study designs and avoid unnecessary RRT for higher patient safety and lower health care costs. View Full-Text
Keywords: acute kidney injury; biomarkers; disease staging; glomerular filtration rate; renal replacement therapy; timing acute kidney injury; biomarkers; disease staging; glomerular filtration rate; renal replacement therapy; timing
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Nusshag, C.; Weigand, M.A.; Zeier, M.; Morath, C.; Brenner, T. Issues of Acute Kidney Injury Staging and Management in Sepsis and Critical Illness: A Narrative Review. Int. J. Mol. Sci. 2017, 18, 1387.

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