Management of acute kidney injury in sepsis

Acute kidney injury and multiorgan dysfunction due to sepsis and septic shock increase the morbidity and mortality among critically ill patients. It remains an important challenge in critically ill patients. In this review, management of septic AKI in terms of prevention, medical therapies, and extracorporeal therapies is discussed. Stabilizing the hemodynamic parameters by fluid resuscitation and inotropic support are important strategies to prevent acute kidney injury in the initial stages. Controversies exist in the timing of initiating renal replacement therapy although some studies showed improved outcomes with early initiation. The recommended dose of renal replacement therapy (25 ml/kg/hr) had not shown to be associated with improved survival in randomized studies. The clinical benefit of other therapies, like hemoadsorption, and alkaline phosphatase use is still uncertain. Mesenchymal stem cell therapies are in phase I trials.