PENGELOLAAN AKUT KIDNEY INJURY DISEBABKAN SEPSIS DI ICU

Authors

  • Suhud Marisi Rumah Sakit Hasan Sadikin Bandung Departemen Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjajaran
  • Suwarman Rumah Sakit Hasan Sadikin Bandung Departemen Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjajaran
  • Tinni T. Maskoen Rumah Sakit Hasan Sadikin Bandung Departemen Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjajaran

Keywords:

sepsis, acute kidney injury

Abstract

Acute Kidney Injury (AKI) is a syndrome that consists of several clinical conditions, due to sudden kidney dysfunction. Sepsis and septic shock are the causes of AKI and are known as Sepsis-Associated AKI (SA-AKI) and account for more than 50% of AKI cases in ICU, with a trend towards a poor prognosis. Acute Kidney Injury (AKI) is characterized by a sudden decrease in kidney function over several hours / day, which results in the accumulation of creatinine, urea and other waste products. The main goals of AKI management are to prevent further kidney damage and to keep the patient alive until the kidney function returns to normal. SA-AKI is a condition often faced by patients with sepsis in the ICU. The method used is based on a literature review regarding the reduction in mortality or success in patient management, in the BEST Kidney trial subgroup analysis, the probability of death in hospital was 50% higher in AKI sepsis compared with non-sepsis AKI. The understanding of sepsis and endotoxin that can cause SA-AKI is not fully known, the conclusion is that rapid identification of the incidence of SA-AKI, antibiotics and appropriate fluid therapy are crucial actions in the management of SA-AKI. The availability of organ support modalities such as CRRT in ICU care can help patients with sepsis survive due to frequent kidney organ failure.

References

Aydogdu M, Gursel G, Sancak B, Yeni S, Sari G, Tasyurek S, Turk M, Yuksel S, Senes M, Ozis TN. The use of plasma and urine neutrophil gelatinase associated lipocalin (NGAL) and cystatin C in early diagnosis of septic acute kidney injury in critically ill patients. Disease Markers. 34(4):237-46. doi: 10.3233/DMA-130966. 2013.

Bagshaw SM, Lapinsky S, Dial S, et al. Cooperative Antimicrobial Therapy*of Septic Shock (CATSS) Database Research Group. Acute kidney injury in septic shock: clinical outcomes and impact of duration of hypotension prior to initiation of antimicrobial therapy. Intensive Care Med. May;35(5):871-81. doi: 10.1007/s00134-008-1367-2. 2009.

Bellomo R, Kellum JA, Ronco C, Wald R, Martensson J, Maiden M, et al. Acute Kidney Injury in Sepsis. Intensive Care Med. Jun;43(6):816-828. doi: 10.1007/s00134-017-4755-7 2017.

Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute Dialysis Quality Initiative workgroup. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. Aug;8(4):R204-12. doi: 10.1186/cc2872. 2004.

Bouman CS,Oudemans-Van Straaten HM, Tijssen JG, ZandstraDF, KeseciogluJ. Effects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: A prospective, randomized trial. Critical Care Medicine. Oct;30(10):2205-11. doi: 10.1097/00003246-200210000-00005. 2002.

Di Nardo M, Ficarella A, Ricci Z, Luciano R, Stoppa F, Picardo S, Picca S, Muraca M, Cogo P. Impact of severe sepsis on serum and urinary biomarkers of acute kidney injury in critically ill children: An observational study. Blood Puri cation. 35(1-3):172-6. doi: 10.1159/000346629. 2013.

Doi K. Role of kidney injury in sepsis. Journal of Intensive Care. 4, 17. 2016.

Gotts JE, Matthay MA. Sepsis: pathophysiology and clinical management. BMJ. doi: https://doi.org/10.1136/bmj.i1585 2016.

Hoste EAJ, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. Aug;41(8):1411-23. doi: 10.1007/s00134-015-3934-7 2015.

KDIGO. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2:1-138. 2012.

Melyda. Diagnosis dan Tatalaksana Acute Kidney Injury (AKI) pada Syok Septik.CKD- 259. 2017.

Liu KD, Himmelfarb J, Paganini E, Ikizler TA, Soroko SH, Mehta RL, Chertow GM. Timing of initiation of dialysis in critically ill patients with acute kidney injury. Clinical Journal of the American Society of Nephrology. Sep;1(5):915-9. doi: 10.2215/CJN.01430406. 2006.

Marik P. E, Taeb A.M., SIRS, qSOFA and new ssepsis definition. J Thorac Dis. Apr; 9(4): 943–945. doi: 10.21037/jtd.2017.03.125. 2017.

Marik PE. Fluid therapy in 2015 and beyond: The mini- fluid challenge and mini- fluid bolus approach. British Journal of Anaesthesiology. Sep;115(3):347-9. doi: 10.1093/bja/aev169 2015.

Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 11(2): R31. doi: 10.1186/cc5713. 2007.

Rajapakse S, Rodrigo C, Wijewickrema E. Management of Sepsis-Induced Acute Kidney Injury. SLJCC. 2009.

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M. Early goal-directed therapy in the treatment of severe sepsis and septic shock. New England Journal of Medicine. 345:1368-1377. DOI: 10.1056/NEJMoa010307. 2001.

Shankar-Hari M, Phillips GS, Levy ML, et al. Sepsis Definitions Task Force. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions*for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016.

Sharfuddin AA, Molitoris BA. Pathophysiology of ischemic acute kidney injury. Nature Review Nephrology. Apr;7(4):189-200. doi: 10.1038/nrneph.2011.16. 2011.

Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016.

Uchino S, Kellum JA, Bellomo R, et al. Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators. Acute renal*failure in critically ill patients: a multinational, multicenter study. JAMA. 2005.

Wang K, Xie S, Xiao K, Yang P, He W, Xie L. Biomarkers of Sepsis-Induced Acute Kidney Injury. BioMed Research International. Apr 24;2018:6937947. doi: 10.1155/2018/6937947. 2018.

Zhang Z. Biomarkes, diagnosis and management of sepsis-induced acute kidney injury: a narrative review. Heart, Lung and Vessels. 7(1): 64–73. 2015.

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Published

2021-06-08 — Updated on 2021-06-11

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