Intended for healthcare professionals

Clinical Review State of the Art Review

Sepsis associated acute kidney injury

BMJ 2019; 364 doi: (Published 09 January 2019) Cite this as: BMJ 2019;364:k4891
  1. Jason T Poston, associate professor of medicine1,
  2. Jay L Koyner, associate professor of medicine2
  1. 1Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL 60637, USA
  2. 2Section of Nephrology, Department of Medicine, University of Chicago
  1. Correspondence to: J L Koyner jkoyner{at}


Sepsis is defined as organ dysfunction resulting from the host’s deleterious response to infection. One of the most common organs affected is the kidneys, resulting in sepsis associated acute kidney injury (SA-AKI) that contributes to the morbidity and mortality of sepsis. A growing body of knowledge has illuminated the clinical risk factors, pathobiology, response to treatment, and elements of renal recovery that have advanced our ability to prevent, detect, and treat SA-AKI. Despite these advances, SA-AKI remains an important concern and clinical burden, and further study is needed to reduce the acute and chronic consequences. This review summarizes the relevant evidence, with a focus on the risk factors, early recognition and diagnosis, treatment, and long term consequences of SA-AKI. In addition to literature pertaining to SA-AKI specifically, pertinent sepsis and acute kidney injury literature relevant to SA-AKI was included.


  • Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors

  • Contributors: Both authors did the literature search and wrote, revised, and edited the manuscript.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: JLK has received consulting fees from Astute Medical, Sphingotec, and Pfizer and research fees from Astute Medical, Bioporto, NxStage Medical, and Satellite Healthcare for work in biomarkers of AKI, not specific to SA-AKI.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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