Acute Kidney Injury and Fluid Resuscitation in Septic Patients: Are We Protecting the Kidney?

Nephron
Jonathan MontomoliCan Ince

Abstract

Acute kidney injury (AKI) is a common complication in critically ill patients, especially among septic patients. Sepsis and hypovolemia are the 2 most frequent etiologies of AKI in intensive care units and frequently coexist in critically ill patients. Effective fluid resuscitation is crucial for the stabilization of sepsis-induced tissue hypoperfusion or septic shock. However, the lack of a goal-directed therapy targeting kidney oxygenation prevents from optimization of the fluid therapy with regard to improvement of renal oxygen delivery and extraction. Similarly, fluid administration as all therapeutic actions carries adverse effects such as the activation of cytokines, disruption of the capillary glycocalyx, and adverse effects on kidney metabolism and oxygenation. Moreover, a positive fluid balance is associated with an increased risk of AKI and is a negative predictor for recovery of renal function. The role of fluid resuscitation on kidney injury stems from the high renal vulnerability to hypoxemic injury. Indeed, fluids have a poor oxygen solubility and hemodilution decreases blood viscosity both promoting intrarenal shunting and heterogeneity with a decreased capillary density and enhanced intrarenal cortex and medulla...Continue Reading

Citations

Jan 16, 2020·Journal of Clinical Medicine·Oana AntalNatalia Hagău
Jun 9, 2020·Critical Care : the Official Journal of the Critical Care Forum·Viveka BjörckThomas Kander
Oct 1, 2020·International Journal of Molecular Sciences·Nadezda PetejovaDavid Stejskal
Aug 13, 2020·Clinical and Experimental Nephrology·Daisuke Nakano
Nov 26, 2020·Microcirculation : the Official Journal of the Microcirculatory Society, Inc·Tuhin K Roy, Timothy W Secomb
May 4, 2021·Current Opinion in Anaesthesiology·Khaschayar Saadat-Gilani, Alexander Zarbock
Sep 18, 2021·Current Opinion in Critical Care·Khaschayar Saadat-Gilani, Alexander Zarbock

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