Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

Abstract

Acute kidney injury (AKI) is a syndrome that has progressed a great deal over the last 20 years. The decrease in urine output and the increase in classical renal biomarkers, such as blood urea nitrogen and serum creatinine, have largely been used as surrogate markers for decreased glomerular filtration rate (GFR), which defines AKI. However, using such markers of GFR as criteria for diagnosing AKI has several limits including the difficult diagnosis of non-organic AKI, also called "functional renal insufficiency" or "pre-renal insufficiency". This situation is characterized by an oliguria and an increase in creatininemia as a consequence of a reduction in renal blood flow related to systemic haemodynamic abnormalities. In this situation, "renal insufficiency" seems rather inappropriate as kidney function is not impaired. On the contrary, the kidney delivers an appropriate response aiming to recover optimal systemic physiological haemodynamic conditions. Considering the kidney as insufficient is erroneous because this suggests that it does not work correctly, whereas the opposite is occurring, because the kidney is healthy even in a threatening situation. With current definitions of AKI, normalization of volaemia is needed before defining AKI in order to avoid this pitfall.

Is the Combination of Piperacillin-Tazobactam and Vancomycin Associated with Development of Acute Kidney Injury? A Meta-analysis

“…In addition, baseline characteristics were reported for only the outcome (AKI vs no AKI) in two studies, whereas all other studies reported a baseline characteristic for the exposure (vancomycin + piperacillin‐tazobactam vs vancomycin ± β‐lactam). According to current guidelines, age (65 yrs or older) and preexisting chronic kidney disease are two of the most important risk factors for developing AKI in hospitalized patients . Other risk factors for AKI include male sex, African origin, obesity (body mass index higher than 40 kg/m 2 ), hypertension, congestive heart failure, hepatocellular insufficiency, diabetes mellitus, cancer, anemia, sepsis, hemodynamic instability, severe respiratory insufficiency, major surgery, severe burn, severe trauma, and nephrotoxic agents.…”

Preoperative hypoalbuminemia was associated with acute kidney injury in high-risk patients following non-cardiac surgery: a retrospective cohort study

“…The study period was from July 1, 2017, to June 30, 2018, with the following inclusion criteria: (1) adult patients (age ≥18 years), (2) undergoing non-cardiac surgery, (3) admitted to the surgical intensive care unit (SICU), and (4) at a high risk of postoperative AKI. High-risk patients referred to as patients having at least one of the following conditions: (1) preoperative comorbidities, including hypertension, diabetes mellitus, coronary heart disease, congestive heart failure, cerebrovascular disease, chronic kidney disease, lung disease, or liver disease; (2) major surgery, defined as surgery duration ≥2 hours; (3) ongoing organ dysfunction, defined as the sequential organ failure assessment (SOFA) score ≥2 from one single organ system.…”

“…Acute kidney injury (AKI) is a common complication after non-cardiac surgery with an incidence ranging from 6.8% to 39.3% according to different patient populations [1,2]. Several underlying susceptibilities, procedures, or exposures have been identified to be risk factors of postoperative AKI occurrence, such as older age, chronic kidney disease, diabetes, sepsis, major surgery, and hemodynamic instability [3]. Recent evidence demonstrated that AKI was independently associated with longer length of hospital stay and higher rate of 30-day hospital readmission, 1-year end-stage renal disease, and mortality with more severe stage of AKI relating to poorer outcomes after noncardiac surgery [4,5].…”

Severe acute kidney injury following major liver resection without portal clamping: incidence, risk factors, and impact on short-term outcomes

“…In 2012, a new classification was suggested by a panel of experts, comprising the Kidney Disease Improving Global Outcomes (KDIGO) criteria. 15 The present study aimed to report the incidence and risk factors of AKI after MH without portal triad clamping, and its impact on postoperative outcomes.…”