Identification and management of sepsis associated-acute kidney injury / 中华危重病急救医学

ABSTRACT

At present, the diagnosis of sepsis associated-acute kidney injury (SA-AKI) mainly relies on monitoring urine volume or serum creatinine (SCr) levels. Due to decreased renal blood supply and the use of diuretics, the diagnosis is intrusive and non-specific. Early identification of the clinical process of SA-AKI and effective management can restore renal function as soon as possible and improve outcomes. This paper discusses the epidemiology, diagnostic limitations, pathophysiological mechanism, treatment and prognosis of SA-AKI. Approximately 30% of patients with sepsis were found to develop acute kidney injury (AKI), and 50% of patients with AKI in the intensive care unit (ICU) were found to have sepsis. Once a diagnosis of SA-AKI is made, close monitoring and timely organ support therapy should be combined to prevent further kidney injury. SA-AKI can be reversed early in the first week after admission, and the prognosis is good. The main mechanisms of organ injury in sepsis are reduced perfusion of bilateral glomeruli, impaired inflammatory response, metabolic adaptation and microcirculation. Etiological control and antibiotic application early play important roles in sepsis management. In addition, fluid resuscitation, vasopressors, early use of renal replacement therapy (RRT), and blood purification are important prognostic factors of SA-AKI.