Acute kidney injury in sepsis

Sepsis is the most common cause of acute kidney injury (AKI) in the intensive care unit. Mortality of AKI is much higher in septic patients compared with nonseptic patients. Septic patients frequently present with a hyperdynamic circulation including primary arterial vasodilation and a secondary increase in cardiac output; renal hemodynamics are often characterized by early vasoconstriction. The elucidation of key components of pathogenesis of sepsis and septic shock has suggested several potential therapies for sepsis, and significant progress has been made in understanding the biology and mechanisms of endotoxin-related AKI; however, translation of this knowledge into improved management and outcome for patients with AKI has not been optimal. This chapter summarizes the hemodynamic and biochemical alterations in sepsis which lead to AKI and addresses the currently available and potential future therapies for the management of sepsis to prevent and treat AKI.