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Acute Kidney Injury in Sepsis

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Abstract

Sepsis is the most common cause of acute kidney injury (AKI) in the intensive care unit. Mortality of AKI is much higher in septic patients compared with nonseptic patients. Septic patients frequently present with a hyperdynamic circulation including primary arterial vasodilation and a secondary increase in cardiac output; renal hemodynamics are often characterized by early vasoconstriction. The elucidation of key components of pathogenesis of sepsis and septic shock has suggested several potential therapies for sepsis, and significant progress has been made in understanding the biology and mechanisms of endotoxin-related AKI; however, translation of this knowledge into improved management and outcome for patients with AKI has not been optimal. This chapter summarizes the hemodynamic and biochemical alterations in sepsis which lead to AKI and addresses the currently available and potential future therapies for the management of sepsis to prevent and treat AKI.

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Acknowledgments

The authors’ research papers cited in the article were supported by NIH Grant 2 RO1 DK052599–09A2. The authors appreciate the editorial assistance of Jan Darling.

Acute kidney injury (AKI) is frequently associated with sepsis. In severe sepsis and septic shock, the incidence of AKI has been reported to be 23% and 51%, respectively [31]. Sepsis is the most common cause of AKI in intensive care units, accounting for approximately 50% of cases [29]. The mortality of AKI is reported to be much higher in septic, as compared with nonseptic, patients (73 vs 45%) [7]. The incidence of sepsis is increasing, in part due to the aging of the population worldwide. In the United States the annual mortality secondary to sepsis is an estimated 210,000, a number which equals or exceeds that due to heart attacks [3].

The management of the patient with sepsis and AKI necessitates an understanding of the multifactorial pathogenesis as discussed in this chapter.

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Authors and Affiliations

  1. University of Colorado School of Medicine, 4200 East Ninth Avenue B173, Biomedical Research Building, Room 723, Denver, CO, 80262, USA

    Robert W. Schrier

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  1. Robert W. Schrier
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  2. Shweta Bansal
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  3. Wei Wang
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Correspondence to Robert W. Schrier .

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Editors and Affiliations

  1. Charité Campus Virchow, Universitätsklinikum Berlin, Augustenburger Platz 1, Berlin, 13353, Germany

    Achim Jörres

  2. Dipto. Nefrologia, Ospedale San Bortolo, Viale Rodolfi 16, Vicenza, 36100, Italy

    Claudio Ronco

  3. School of Medicine, University of Pittsburgh, Terrace Street 3550, Pittsburgh, 15261, U.S.A.

    John A. Kellum

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Schrier, R.W., Bansal, S., Wang, W. (2010). Acute Kidney Injury in Sepsis. In: Jörres, A., Ronco, C., Kellum, J. (eds) Management of Acute Kidney Problems. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-69441-0_28

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  • DOI: https://doi.org/10.1007/978-3-540-69441-0_28

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