Intrinsic Acute Kidney Injury

Abstract

Acute kidney injury (AKI) in the intensive care unit (ICU) can be the result of a wide range of disease processes, so that it is likely to be encountered by physicians from all specialties. The increasing recognition of the overlap between critical care medicine and nephrology has resulted in what nowadays is called critical care nephrology. Nephrologists should be familiar with the rapid advances in the field of intensive care medicine and the impact these advances may have on the occurrence of AKI in these patients. At the same time, the intensivist should also consider the kidney in the management of critically ill patients. The nondialytic therapy of practically all patients with AKI includes optimising renal perfusion with volume expansion, use of inotropes and vasopressors, and eventually trials with loop diuretics. The moment of initiation of renal replacement therapy (RRT), the selection of the RRT modality, and the dose and frequency of ­dialysis should be decided in daily consultations between nephrologist and intensivist. Flex-ibility and willingness to listen and to take the advice of both teams is a great asset which can only be to the advantage of the critically ill patient. The slow but steady improvement of the, at least short-term, prognosis of the patient with AKI is testimony to this growing cooperation between the two disciplines. In recent years, it has been recognised that the term acute renal failure (ARF) fails to adequately describe what is a dynamic process extending across initiation, maintenance and recovery phases, each of which may be of variable duration and severity [1].The term acute renal failure suggests that the syndrome is dichotomous and places an undue emphasis on whether or not renal function has overtly failed. This belies the now well-established fact that even mild decrements in glomerular filtration may be associated with adverse clinical outcomes. The alternative proposed term acute kidney injury (AKI) better captures the diverse nature of this syndrome, and has entered into widespread clinical use