Pathophysiology and Management of Acute Kidney Injury in the Setting of Abdominal Compartment Syndrome

Abstract

Abdominal compartment syndrome (ACS) is defined as an organ dysfunction caused by intra-abdominal hypertension (IAH). Up to 4.2% of the patients in intensive care unit may develop IAH with it being an independent predictor of mortality. However, overall, it still remains a relatively underdiagnosed condition, part in because physical examination alone is very unreliable. Acute kidney injury is one of the most consistently described organ dysfunctions with oliguria being one of the earliest clinical signs of IAH. We recommend that any patient with evidence of new onset oliguria in the setting of distended abdomen, unexplained respiratory failure, with or without hypotension should be suspected of having IAH/ACS. Intravesicular pressure measurement represents a safe, rapid, and cost-effective method of diagnosing IAH. We hereby review the pathophysiology, diagnosis, and management of ACS and its association with acute kidney injury.

Acute kidney injury due to abdominal compartment syndrome caused by duodenal metastases of prostate cancer

“…Serial measurements of IAP are recommended for diagnosis. Intravesicular pressure is a good estimate for IAP, is easily measured .…”

“…Main cause of ACS is intra abdominal hypertension (IAH) due to various factors such as abdominal surgery, ileus, intestinal obstruction, intraabdominal malignancy, and organomegaly. The most important clinical presentations of ACS are symptoms due to abdominal distension , acute oliguria, and respiratory problems . We report a patient with external compression of distal duodenal segment due to the metastatic lymph nodes and acute kidney injury (AKI) as a result of ACS.…”

The risk for end-stage renal disease is increased after burn

“…The pathophysiology of AKI in the setting of burn is most likely related to the longer duration of inflammatory response [15,16] rather than to the decreased renal perfusion [17]. That said, intra-abdominal hypertension and abdominal compartment syndrome due to excessive fluid resuscitation [18,19] or rhabdomyolysis [20,21] may also lead to development of AKI [22,23].…”

Impending abdominal compartment syndrome from a giant ovarian cyst torsion

“…ACS is defined as organ dysfunction caused by intra‐abdominal hypertension (IAH) . Acute kidney injury with oliguira is the most common organ dysfunction and dyspnoea being one of the earliest clinical signs . There are three different types of ACS.…”

“…Secondary ACS is due to massive bowel oedema due to sepsis, capillary leak or burns causing a swelling effect and tertiary ACS reoccurs after resolution of a primary or secondary ACS . These cause an increase in the IAP and reduced abdominal perfusion pressure leading to bowel ischaemia and systemic hypoperfusion causing end‐organ dysfunction and oedema . Organ dysfunction occurs in ACS due to either direct compressive effects onto organs or inadequate end‐organ perfusion as a result of decreased abdominal perfusion pressure secondary to increased IAP and decreased cardiac output …”