Sepsis and Kidney Injury

Abstract

Clinical Background: Clinical infections and its most severe forms sepsis and septic shock are commonly associated with changes in kidney function. This acute kidney injury (AKI) is associated with increased risk of morbidity and mortality in hospitalized patients. Epidemiology: Recent standardized, separate consensus definitions of sepsis and AKI have informed the epidemiology of these 2 distinct processes. While there is no consensus definition specific to sepsis-associated AKI, several studies have utilized the combined definitions of these two syndromes to identify those patients at the highest risk for adverse outcomes. Challenges: Prevention of sepsis-associated AKI is difficult in part because patients will often present for medical care with the sepsis-associated AKI already clinically apparent. Additionally, for those that do not have AKI on presentation the ability to detect injury early is limited by the imperfect current gold standard biomarkers serum creatinine and urine output. Prevention and Treatment: Despite these challenges, there has been increased investigation of novel biomarkers of AKI. Additionally, there has been intense investigation into the ideal care of patients with sepsis, AKI as well as sepsis-associated AKI. While there are limited specific therapeutic options outside of antibiotics for infections, several studies have investigated the use of care bundles to treat these syndromes. While there is continued investigation into novel therapeutics and the use of dialysis and extracorporeal modalities, these trials have failed to revolutionize clinical care. This review summarizes the current state of sepsis-associated AKI care and discusses strategies to improve care.