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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.

Author information

1
The Renal and Metabolic Division, The George Institute for Global Health, Level 5, 1 King Street, Newtown, New South Wales 2042, Australia.
2
Concord Clinical School, The University of Sydney, New South Wales 2139, Australia.
3
The Sydney Adventist Hospital, Wahroonga, Sydney, New South Wales 2076, Australia.
4
Intensive Care Unit, The Royal Melbourne Hospital, Parkville, Melbourne, Victoria 3050, Australia.
5
School of Medicine, University of Melbourne, Parkville, Melbourne, Victoria 3010, Australia.

Abstract

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.

PMID:
28869251
DOI:
10.1038/nrneph.2017.119
[Indexed for MEDLINE]

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