THE KIDNEY IN THE CRITICALLY ILL

Abstract

Acute kidney injury (AKI) is a common and serious complication in the intensive care setting. It seldom occurs in isolation, but is mostly part of a multiple organ dysfunction syndrome (1-3). The pathogenesis is frequently multifactorial, with sepsis contributing to 50% of the cases (1,4,5). The development of AKI in critically-ill patients is “bad news”: patients with AKI have a high morbidity and mortality (6,7). In addition, AKI, even in its mildest from, is not only a marker of illness severity but appears to be independently associated with mortality (8-12). Prevention of AKI is therefore a major goal to improve outcome of critically-ill patients. Treatment of established AKI is largely supportive. The optimal modality for renal replacement therapy in critically-ill patients still remains a matter of debate (13,14). The majority of survivors recover renal function (15-18).

Keywords:

• acute kidney injury
• critically-ill patients
• pathophysiology
• prevention
• renal replacement therapy
• prognosis