Recent Strategies in Prevention and Management of Acute Kidney Injury in Critically Ill Patients

Abstract

Acute kidney injury is a clinical syndrome defined by a rise in serum creatinine and/or fall in urine output as per KDIGO classification. Future definitions are likely to incorporate novel functional and damage biomarkers to characterise AKI better. Early diagnosis and appropriate diagnostic work-up are essential to determine the underlying aetiology and to identify cases of AKI that require specific and timely therapeutic interventions. The exact diagnostic investigations depend on the clinical context and should include routine baseline tests as well as more specific and novel tools. AKI has been linked to sepsis and inflammation, as the kidney is very sensitive to hypoperfusion. The kidney is also sensitive to many of our interventions, such as mechanical ventilation and excessive fluid resuscitation. Positive pressure ventilation can lead to hemodynamic changes and also the systemic release of cytokines that can impact renal function. It may be time to search more closely for specific causes, assess more carefully the prevalence of aetiologies even when typical symptoms are misleadingly absent-such as acute postinfectious glomerulonephritis or AIN-and, ultimately, reshape an old-fashioned and probably outdated AKI diagnostic paradigm. 100 Summary Fluid therapy during resuscitation can also result in renal impairment, including all forms of fluid therapy. Crystalloids and