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 RimmeléEric Rondeau, Fabienne Tamion, Yannick Walrave, Lionel Velly

Research output: Contribution to journalReview ArticleOtherpeer-review

26 Citations (Scopus)

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.

Original languageEnglish
Article number48
Number of pages20
JournalAnnals of Intensive Care
Volume6
Issue number1
DOIs
Publication statusPublished - 1 Dec 2016
Externally publishedYes

Cite this

Ichai, C., Vinsonneau, C., Souweine, B., Armando, F., Canet, E., Clec’h, C., Constantin, J. M., Darmon, M., Duranteau, J., Gaillot, T., Garnier, A., Jacob, L., Joannes-Boyau, O., Juillard, L., Journois, D., Lautrette, A., Muller, L., Legrand, M., Lerolle, N., ... Velly, L. (2016). Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies). Annals of Intensive Care, 6(1), [48]. https://doi.org/10.1186/s13613-016-0145-5