Acute kidney injury in the intensive care unit: An update and primer for the intensivist

Objective. Acute kidney injury is common in critically ill patients and is associated with significant morbidity and mortality. Patients across the spectrum of critical illness have acute kidney injury. This requires clinicians from across disciplines to be familiar with recent advances in definitions, diagnosis, prevention, and management of acute kidney injury in the intensive care unit. The purpose of this concise review, therefore, is to address, for the non-nephrologist, clinically relevant topical questions regarding acute kidney injury in the intensive care unit. Data Sources: The authors (nephrologists and intensivists) performed a directed review of PubMed to evaluate topics including the definition, diagnosis, prevention, and treatment of acute kidney injury in the intensive care unit. The goal of this review is to address topics important to the practicing intensivist. Data Synthesis and Findings: Whenever available, preferential consideration was given to randomized controlled trials. In the absence of randomized trials, observational and retrospective studies and consensus opinions were included. Conclusions. Acute kidney injury in the intensive care unit is a clinically relevant problem requiring awareness and expertise among physicians from a wide variety of fields. Although many questions remain controversial and without definitive answers, a periodic update of this rapidly evolving field provides a framework for understanding and managing acute kidney injury in the intensive care unit. (Crit Care Med 2010; 38:261-275)