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

Carole Ichai, Christophe Vinsonneau, Bertrand Souweine, Fabien Armando, Emmanuel Canet, Christophe Clec'h, Jean-Michel Constantin, Michaël Darmon, Jacques Duranteau, Théophille Gaillot, Arnaud Garnier, Laurent Jacob, Olivier Joannes-Boyau, Laurent Juillard, Didier Journois, Alexandre Lautrette, Laurent Muller, Matthieu Legrand, Nicolas Lerolle, Thomas Rimmelé, Eric Rondeau, Fabienne Tamion, Yannick Walrave, Lionel Velly, Société française d’anesthésie et de réanimation (Sfar), Société de réanimation de langue française (SRLF), Groupe francophone de réanimation et urgences pédiatriques (GFRUP), Société française de néphrologie (SFN), Carole Ichai, Christophe Vinsonneau, Bertrand Souweine, Fabien Armando, Emmanuel Canet, Christophe Clec'h, Jean-Michel Constantin, Michaël Darmon, Jacques Duranteau, Théophille Gaillot, Arnaud Garnier, Laurent Jacob, Olivier Joannes-Boyau, Laurent Juillard, Didier Journois, Alexandre Lautrette, Laurent Muller, Matthieu Legrand, Nicolas Lerolle, Thomas Rimmelé, Eric Rondeau, Fabienne Tamion, Yannick Walrave, Lionel Velly, Société française d’anesthésie et de réanimation (Sfar), Société de réanimation de langue française (SRLF), Groupe francophone de réanimation et urgences pédiatriques (GFRUP), Société française de néphrologie (SFN)

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.

Figures

Fig. 1
Fig. 1
Acute kidney disease: from attack to dysfunction

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Source: PubMed

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