Acute kidney insufficiency (AKI), or injury, is common in the critically ill patient. Minimal increases in serum creatinine (Scr) have been associated with greater morbidity, mortality, and hospital cost. In 2002, the Acute Dialysis Quality Initiative (ADQI) proposed a consensus definition (the RIFLE classification) which was modified after continuing evidence suggested that small changes in Scr (≥0.3 mg/dL) led to worsening outcomes. This group, known as the Acute Kidney Injury Network (AKIN), suggests 3 stages of worsening kidney function. Such definitions may aid in identifying patients at greatest risk and further the development of preventive strategies. This review will focus on the epidemiology and etiology of AKI as well as provide a mechanistic description of drug-induced AKI. In addition, a brief review of continuous renal replacement therapies is provided.
ShustermanNStromBLMurrayTG. Risk factors and outcome of hospital-acquired acute renal failure. Am J Med. 1987;83(1):65–71.
2.
HouSHBushinskyDAWishJB. Hospital-acquired renal insufficiency: a prospective study. Am J Med. 1983;74(2):243–248.
3.
NashKHafeezAHouS. Hospital-acquired renal insufficiency. Am J Med. 2002;39(5):930–936.
4.
ClermontGAckerCGAngusDC. Renal failure in the ICU: comparison of the impact of acute renal failure and end-stage renal disease on ICU outcomes. Kidney Int. 2002;62(3):986–996.
5.
ChertowGMBurdickEHonourM. Acute kidney injury, mortality, length of stay, and cost in hospitalized patients. J Am Soc Nephrol. 2005;16(11):3365–3370.
6.
HosteEKellumJA. Incidence, classification, and outcomes of acute kidney injury. Contrib Nephrol. 2007;156:32–38.
7.
BehrendTMillerSB. Acute renal failure in the cardiac care unit: etiologies, outcomes, and prognostic factors. Kidney Int. 1999;56(1):238–243.
8.
PisoniRWilleKMTolwaniAJ. The epidemiology of severe acute kidney injury: from BEST to PICARD, in acute kidney injury: new concepts. Nephron Clin Pract. 2008;109(4):c188–c191.
9.
RicciZRoncoC. Today’s approach to the critically ill patient with acute kidney injury. Blood Purif. 2009;27(1):127–134.
10.
MetnizPGKrennCGSteltzerH. Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med. 2002;30(9):2051–2058.
11.
LianoFJuncoEPascualJ. The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. The Madrid Acute Renal Failure Study Group. Kidney Int Suppl. 1998;66:S16–S24.
12.
VincentJL. Incidence of acute renal failure in the intensive care unit. Contrib Nephrol. 2001;132:1–6.
13.
BrivetFGKleinknechtDJLoiratP. Acute renal failure in intensive care units: causes, outcome, and prognostic factors of hospital mortality—a prospective, multicenter study. French Study Group on Acute Renal Failure. Crit Care Med. 1996;24(2):192–198.
14.
LianoFPascualJ. Outcomes in acute renal failure. Semin Nephrol. 1998;18:541–550.
15.
UchinoSKellumJABellomoR. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294(7):813–818.
16.
MehtaRLPascualMTSorokoS. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 2004;66(4):1613–1621.
17.
MehtaRLChertowGM. Acute renal failure definitions and classification: time for change?. J Am Soc Nephrol. 2003;14(8):2178–2187.
18.
BellomoRRoncoCKellumJA. Acute Dialysis Quality Initiative Workgroup: acute renal failure–definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204–R212.
19.
LassniggASchmidlinDMouhieddineM. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol. 2004;15(6):1597–1605.
20.
CocaSGPeixotoAJGargAX. The prognostic importance of a small acute decrement in kidney function in hospitalized patients: a systematic review and meta-analysis. Am J Kidney Dis. 2007;50(5):712–720.
21.
MehtaRLKellumJAShahSV. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31.
22.
BrochardLAbrougFBrennerM. An official ATS/ERS/ESICM/SCCM/SRLF statement: prevention and management of acute renal failure in the ICU patient. Am J Respir Crit Care Med. 2010;181(10):1128–1155.
23.
DennenPDouglasISAndersonR. Acute kidney injury in the intensive care unit: an update and primer for the intensivist. Crit Care Med. 2010;38(1):261–275.
24.
CockcroftDWGaultMH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31–42.
25.
CrowleySTPeixotoAJ. Acute kidney injury in the intensive care unit. Clin Chest Med. 2009;30(1):29–43.
26.
SoniSSRoncoCKatzN. Early diagnosis of acute kidney injury: the promise of novel biomarkers. Blood Purif. 2009;28(3):165–174.
27.
MishraJDentCTarabishiR. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet. 2005;365(9466):1231–1238.
28.
WagenerGJanMKimM. Association between increases in urinary neutrophil gelatinase-associated lipocalin and acute renal dysfunction after adult cardiac surgery. Anesthesiology. 2006;105(3):485–491.
29.
TuladharSMPuntmannVOSoniM. Rapid detection of acute kidney injury by plasma and urinary neutrophil gelatinase-associated lipocalin after cardiopulmonary bypass. J Cardiovasc Pharmacol. 2009;53(3):261–266.
30.
HirschRDentCPfriemH. NGAL is an early predictive biomarker of contrast-induced nephropathy in children. Pediatr Nephrol. 2007;22(12):2089–2095.
31.
WheelerDSDevarajanPMaQ. Serum neutrophil gelatinase-associated lipocalin (NGAL) as a marker of acute kidney injury in critically ill children with septic shock. Crit Care Med. 2008;36(4):1297–1304.
32.
MakrisKMarkouNEvodiaE. Urinary neutrophil gelatinase-associated lipocalin (NGAL) as an early marker of acute kidney injury in critically ill multiple trauma patients. Clin Chem Lab Med. 2009;47(1):79–82.
33.
Bachorzewska-GajewskaHMalyszkoJSitniewskaE. Neutrophil gelatinase-associated lipocalin (NGAL) correlations with cystatin C, serum creatinine and EGFR in patients with normal serum creatinine undergoing coronary angiography. Nephrol Dial Transplant. 2007;22(1):295–296.
34.
Herget-RosenthalSMarggrafGHusingJ. Early detection of acute renal failure by serum cystatin C. Kidney Int. 2004;66(3):1115–1122.
35.
ParikhCRAbrahamEAncukiewiczM. Urine IL-18 is an early diagnostic marker for acute kidney injury and predicts mortality in the intensive care unit. J Am Soc Nephrol. 2005;16(10):3046–3052.
36.
ParikhCRMishraJThiessen-PhilbrookH. Urinary IL-18 is an early predictive biomarker of acute kidney injury after cardiac surgery. Kidney Int. 2006;70(1):199–203.
37.
HanWKBailyVAbichandaniR. A novel biomarker for human renal proximal tubule injury. Kidney Int. 2002;62(1):237–244.
38.
HanWKWaikarSSJohnsonA. Urinary biomarkers in the early diagnosis of acute kidney injury. Kidney Int. 2008;73(7):863–869.
39.
LiangXLLiuSXChenYH. Combination of urinary kidney injury molecule-1 and interleukin-18 as early biomarker for the diagnosis and progressive assessment of acute kidney injury following cardiopulmonary bypass surgery: a prospective nested case-control study. Biomarkers. 2010;15(4):332–339.
40.
TaberSSPaskoDA. The epidemiology of drug-induced disorders: the kidney. Expert Opin Drug Saf. 2008;7(6):679–690.
41.
GuoXNzerueC. How to prevent, recognize, and treat drug-induced nephrotoxicity. Cleve Clin J Med. 2002;69(4):289–312.
HoitsmaAJWetzelsJFKoeneRA. Drug-induced nephrotoxicity. Drug Saf. 1991;6:131–147.
45.
BentleyMLCorwinHLDastaJD. Drug-induced acute kidney injury in the critically ill adult: recognition and prevention strategies. Crit Care Med. 2010;38(6 suppl):S169–S174.
OlbrichtCTFinkMGutjahrE. Alterations in lysosomal enzymes of the proximal tubule in gentamicin nephrotoxicity. Kidney Int. 1991;39(4):639–646.
49.
McCulloughPA. Contrast-induced acute kidney injury. J Am Coll Cardiol. 2008;51(15):1419–1428.
50.
PerssonPBHansellPLissP. Pathophysiology of contrast medium-induced nephropathy. Kidney Int. 2005;68(1):14–22.
51.
McCulloughPAAdamABeckerCR. Risk prediction of contrast-induced nephropathy. Am J Cardiol. 2006;98(6A):27K–36K.
52.
DangasGIakovouINikolskyE. Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables. Am J Cardiol. 2005;95(1):13–19.
53.
PannuNNadimMK. An overview of drug-induced acute kidney injury. Crit Care Med. 2008;36(4 suppl):S216–S223.
54.
MichelDMKellyCJ. Acute interstitial nephritis. J Am Soc Nephrol. 1998;9:506–515.
55.
SawyerMHWebbDEBalowJE. Acyclovir-induced renal failure. Clinical course and histology. Am J Med. 1988;84(6):1067–1071.
56.
KeeneyREKirkLEBridgenD. Acyclovir tolerance in humans. Am J Med. 1982;73(1A):176–181.
57.
TreonSPChabnerBA. Concepts in use of high-dose methotrexate therapy. Clin Chem. 1996;42(8 pt 2):1322–1329.
58.
SchortgenFSoubrierNDelclauxC. Hemodynamic tolerance of intermittent hemodialysis in critically ill patients: usefulness of practice guidelines. Am J Respir Crit Care Med. 2000;162(1):197–202.
59.
ClarkWRMuellerBAKrausMA. Extracorporeal therapy requirements for patients with acute renal failure. J Am Soc Nephrol. 1997;5(5):804–812.
60.
KramerPWiggerWReigerJ. Arteriovenous haemofiltration: a new and simple method for treatment of over-hydrated patients resistant to diurestics. Klin Wochenschr. 1977;55(22):1121–1122.
61.
GolperTAWedelSKKaplanAA. Drug remaoval during continuous arteriovenus hemofiltration theory and clinical observations. Int J Artif Organs. 1985;8(6):307–312.
62.
MuellerBAScarimSKMaciasWL. Comparison of imipenem pharmacokinetics in patients with acute or chronic renal failure treated with continuous hemofiltration. Am J Kidney Dis. 1993;21(2):172–179.
