Septic acute renal failure

Abstract

Acute renal failure (ARF) is the rapid loss of the renal filtration function, which is characterized by metabolic acidosis, high potassium levels, a body fluid imbalance, and so on. The overall mortality rate of ARF is about 45%; however, the mortality rate of sepsis-induced ARF is about 70%. In addition, sepsis is the most common trigger of ARF. Little is known about the pathogenesis of septic ARF, although renal hypoperfusion and ischemia have been proposed as being central. Blood purification therapies for septic ARF include the elimination of pathogenesis, such as endotoxin or mediators that contribute to ARF, and renal replacement therapy (RRT). The adsorption of endotoxin with direct hemoperfusion using polymyxin-B immobilized fiber makes the urinary output increase, while also improving renal function. It would seem logical to initiate RRT earlier rather than later, especially in rapidly developing symptomatic oliguric renal failure with metabolic derangement. Continuous RRT (CRRT) has an advantage over intermittent RRT in that it provides greater hemodynamic stability, easier fluid removal and greater flexibility in providing parenteral nutrition as a result of a greater control over the fluid balance. CRRT may be able to reduce chronic dialysis dependence. Patients with sepsis and ARF are hyper-catabolic. Some studies have suggested that increased doses of dialysis improve survival in patients who are hypercatabolic and have ARF. The increase in the ultrafiltration rate may, however, be associated with some difficulties, namely cost and labor. The mechanisms of septic ARF therefore need to be further elucidated and the potential of RRT in improving the mortality associated with ARF needs to be established.