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Nat Rev Nephrol. 2017 Nov;13(11):697-711. doi: 10.1038/nrneph.2017.119. Epub 2017 Sep 4.

Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment.

Wang Y1,2,3, Bellomo R1,4,5.

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The Renal and Metabolic Division, The George Institute for Global Health, Level 5, 1 King Street, Newtown, New South Wales 2042, Australia.
Concord Clinical School, The University of Sydney, New South Wales 2139, Australia.
The Sydney Adventist Hospital, Wahroonga, Sydney, New South Wales 2076, Australia.
Intensive Care Unit, The Royal Melbourne Hospital, Parkville, Melbourne, Victoria 3050, Australia.
School of Medicine, University of Melbourne, Parkville, Melbourne, Victoria 3010, Australia.


Cardiac surgery-associated acute kidney injury (CSA-AKI) is the most common clinically important complication in adult patients undergoing open heart surgery, and is associated with increased mortality and morbidity. In patients in intensive care units, CSA-AKI is the second most common type of AKI after septic AKI. In this Review, we explore the definition of CSA-AKI, discuss its epidemiology and identify its risk factors. We discuss current theories of the pathophysiology of CSA-AKI and describe its clinical course. Furthermore, we introduce diagnostic tools with particular reference to novel biomarkers of AKI and their potential utility; we analyse currently applied interventions aimed at attenuating AKI in patients undergoing cardiac surgery; and describe evidence from randomized controlled trials aimed at preventing or treating CSA-AKI. Finally, we explore issues in the use of renal replacement therapy, its timing, its intensity and its preferred modalities in patients with CSA-AKI, and we discuss the prognosis of CSA-AKI in terms of patient survival and kidney recovery.

[Indexed for MEDLINE]

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