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Atypical Sepsis-Associated Acute Kidney Injury

  • J. A. KellumEmail author
  • K. F. Kernan
  • J. A. Carcillo
Chapter
Part of the Annual Update in Intensive Care and Emergency Medicine book series (AUICEM)

Abstract

The overall incidence of acute kidney injury (AKI) in the USA is estimated to be about 7/1000 population [1]. Older adults and children are disproportionately affected in a bimodal distribution mirroring the incidence of sepsis [2], the leading cause of AKI [3–6]. Even mild forms of AKI are associated with increased risk of hospital mortality [6, 7], and AKI may result in chronic kidney disease and life-long morbidity, shortened survival and increased costs [8]. Moreover, severity of AKI varies by etiology and sepsis-associated AKI tends to be most severe. For example, KDIGO stage 3 occurs in <5% of patients undergoing cardiac surgery, but in >20% of patients with septic shock [9]. Once acquired, the consequences of AKI are also unequally distributed. Approximately one third of patients exhibit no reversal of renal dysfunction within the first few days of AKI. Roughly 25% will never recover, and experience a fivefold increase in mortality over the ensuing year [10]. Even among patients with sepsis-associated AKI, outcomes are heterogeneous and different mechanisms may be involved [11]—indeed, no fewer than six have been proposed [12]. Renal endothelial pathology is prevalent in experimental models of sepsis [12, 13]. Endothelial injury can reduce microcirculatory flow leading to perfusion abnormalities and interstitial infiltration of inflammatory cells [13]. However, the reasons some patients exhibit these pathologic features while others do not are obscure.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • J. A. Kellum
    • 1
    • 2
    Email author
  • K. F. Kernan
    • 2
    • 3
  • J. A. Carcillo
    • 1
    • 2
    • 3
  1. 1.Center for Critical Care NephrologyUniversity of PittsburghPittsburghUSA
  2. 2.Department of Critical Care MedicineUniversity of PittsburghPittsburghUSA
  3. 3.Children’s Hospital of Pittsburgh of UPMCPittsburghUSA

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