Sepsis and AKI: more complex than just a simple question of chicken and egg

Excerpt

Acute kidney injury (AKI) in critically ill patients has been largely regarded as a consequence but not as a cause of sepsis [1, 2]. Indeed, most studies focused on incidence, risk factors, and prognosis of sepsis-induced AKI [3] demonstrating its association with a high mortality rate [4] as well as longer hospital stay [5]. Studies addressing the underlying histopathology and pathophysiology of septic AKI have revealed that renal blood flow, both medullar and cortical, was maintained and even increased during severe septic shock [6], undermining earlier concepts and reinforcing the hypothesis that septic AKI is a separate physiological entity from nonseptic AKI. Further evidence for this was provided when it was demonstrated that there was an important role for apoptosis, rather than just necrosis, in sepsis and septic shock [7, 8]. …