Acute kidney injury and multiple organ dysfunction syndrome

Acute kidney injury occurs in approximately 30% patients admitted to the intensive care unit and is commonly associated with multiple organ dysfunction syndrome. A decade ago, acute kidney injury was thought to be a benign entity that could be managed easily with supportive care and dialysis. It is now known that acute kidney injury has a tremendous negative impact on patient morbidity and mortality. Although epidemiologic data clearly demonstrate that acute kidney injury is independently associated with increased mortality, the mechanisms by which acute kidney injury causes death remain unclear. One explanation for the increased mortality is that acute kidney injury causes deleterious systemic effects including injury to other organs. In this review, clinical and experimental data demonstrating the role of acute kidney injury in affecting inflammation and distant organ dysfunction will be discussed with the view that acute kidney injury is a critical factor in the development and maintenance of multiple organ dysfunction syndrome. Current recommendations regarding management of AKI in light of these data and recent clinical trials will also be discussed.