The prevention of acute kidney injury: an in-depth narrative review Part 1: volume resuscitation and avoidance of drug- and nephrotoxin-induced AKI
1 Department of Medicine, University Hospital
2 Division of Nephrology, University Hospital
3 Intensive Care Unit, University Hospital, Ghent, Belgium
Correspondence: Correspondence and offprint requests to: Norbert Lameire, Department of Medicine, University Hospital, 185, De Pintelaan, 9000 Gent, Belgium. Tel: +32-9-3718830; Fax: +32-(0)9-332-4403; E-mail: Norbert.lameire{at}ugent.be
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Abstract |
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This narrative clinical review in two parts discusses the prevention of clinical acute kidney injury (AKI). The first part focuses on general prevention measures, including identification of individuals at high risk for AKI, and on the role of volume expansion and fluid therapy. The latter discusses the timing, the goals, the selection of the fluids and the haemodynamic management of the patient receiving parenteral fluids for the prevention of AKI. In addition, this part summarizes the interaction of intensivist-nephrologist in the ICU with attention to tight glycaemia control and the use of low doses of corticoids in the septic shock patients. Finally, the avoidance of drug- and nephrotoxin-induced AKI is discussed. The second part of this review will summarize the possible pharmacological interventions in the patient at risk.
Key Words: acute kidney injury • fluid therapy • prevention • tight glycaemia control • volume expansion
Received for publication October 2, 2008. Accepted for publication October 2, 2008.