The prevention of acute kidney injury: an in-depth narrative review Part 1: volume resuscitation and avoidance of drug- and nephrotoxin-induced AKI

Abstract

This narrative clinical review in two parts discusses the prevention of clinical acute kidney injury (AKI). The first part focuses on general prevention measures, including identification of individuals at high risk for AKI, and on the role of volume expansion and fluid therapy. The latter discusses the timing, the goals, the selection of the fluids and the haemodynamic management of the patient receiving parenteral fluids for the prevention of AKI. In addition, this part summarizes the interaction of intensivist-nephrologist in the ICU with attention to tight glycaemia control and the use of low doses of corticoids in the septic shock patients. Finally, the avoidance of drug- and nephrotoxin-induced AKI is discussed. The second part of this review will summarize the possible pharmacological interventions in the patient at risk.

Keywords: acute kidney injury; fluid therapy; prevention; tight glycaemia control; volume expansion.

Fig. 1

A conceptual framework of acute kidney injury. The process of AKI can be divided into various reversible stages depending on the severity of insult, starting from the increased risk to damage followed by a decrease in glomerular filtration rate (GFR) further progressing to kidney failure and death (modified from [3]).

Fig. 2

Continuum of volume responsiveness and non-responsiveness in AKI (from [9]).