Acute Kidney Injury in Sepsis.
Telma PaisSofia JorgeJosé António LopesPublished in: International journal of molecular sciences (2024)
Sepsis-associated kidney injury is common in critically ill patients and significantly increases morbidity and mortality rates. Several complex pathophysiological factors contribute to its presentation and perpetuation, including macrocirculatory and microcirculatory changes, mitochondrial dysfunction, and metabolic reprogramming. Recovery from acute kidney injury (AKI) relies on the evolution towards adaptive mechanisms such as endothelial repair and tubular cell regeneration, while maladaptive repair increases the risk of progression to chronic kidney disease. Fundamental management strategies include early sepsis recognition and prompt treatment, through the administration of adequate antimicrobial agents, fluid resuscitation, and vasoactive agents as needed. In septic patients, organ-specific support is often required, particularly renal replacement therapy (RRT) in the setting of severe AKI, although ongoing debates persist regarding the ideal timing of initiation and dosing of RRT. A comprehensive approach integrating early recognition, targeted interventions, and close monitoring is essential to mitigate the burden of SA-AKI and improve patient outcomes in critical care settings.
Keyphrases
- acute kidney injury
- end stage renal disease
- chronic kidney disease
- cardiac surgery
- peritoneal dialysis
- stem cells
- ejection fraction
- newly diagnosed
- septic shock
- single cell
- staphylococcus aureus
- physical activity
- cell therapy
- intensive care unit
- endothelial cells
- early onset
- patient reported outcomes
- mesenchymal stem cells
- high glucose
- combination therapy