AKI Associated with Acute Pancreatitis

Abstract

Acute pancreatitis is a common disorder of the pancreas. It is the most frequent gastrointestinal cause for hospitalization and one of the leading causes of in-hospital deaths. Its severity ranges from mild self-limited disease to severe acute necrotizing pancreatitis characterized by systemic complications and multiorgan failure. Severe acute pancreatitis develops in about 20% of patients with acute pancreatitis and may be associated with multiorgan failure (respiratory, cardiovascular, and kidney). AKI is a frequent complication of severe acute pancreatitis and develops late in the course of the disease, usually after the failure of other organs. It carries a very poor prognosis, particularly if kidney replacement therapy is required, with mortality rates exceeding 75%. The exact pathophysiology of AKI in acute pancreatitis remains unclear but appears to result from initial volume depletion followed by complex vascular and humoral factors. Here, we provide an overview of the epidemiology, pathogenesis, causes, and management of AKI in patients with severe acute pancreatitis.

Keywords: Abdominal Compartment Syndrome; Acute Kidney Injury; Acute Pancreatitis; Hospital Mortality; Hypovolemia; Kidney Replacement Therapy; Multiple Organ Failure; Pancreatitis, Acute Necrotizing; Prognosis; Renal Replacement Therapy; hospitalization; kidney.

Figure 1.

Premature activation of pancreatic enzymes within the acinar cells leads to autodigestion of the pancreas and release of enzymes and proteases which trigger a cascade of events that contribute to the pathogenesis of AKI.

Figure 2.

AKI in severe acute pancreatitis usually results from volume depletion due to extravasation of fluids from the vascular space followed by complex interactions between inflammatory, vascular and humoral factors.

Figure 3.

Management of AKI in acute pancreatitis requires a multidisciplinary approach that begins in the emergency department. This involves providing supportive care, close monitoring of kidney function and treatment of pancreatitis related complications. Escalation of therapy to a higher level of care, providing KRT and surgical treatment might be required if the initial therapy fails. CRRT, continuous RRT; ICU, intensive care unit; IV, intravenous; NSAIDs, nonsteroidal anti-inflammatory drugs.