Sepsis associated acute kidney injuryBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.k4891 (Published 09 January 2019) Cite this as: BMJ 2019;364:k4891
All rapid responses
To whom it may concern
I am writing this in response to the article “Sepsis associated acute kidney injury” published on January 9th 2019 on BMJ Open. I would like to start off by saying that the article was very informative and gave insight into what sepsis is with a focus on the risk factors, early recognition and diagnosis, treatment, and long term consequences of sepsis associated acute kidney injury. I realized that the authors are very passionate about this topic and did a good job with the information being presented in the article. Many people do not realize how important our kidneys are until it is no longer functioning and there are many people suffering from acute kidney injury daily that are unaware that this injury can lead to sepsis which is extremely life threatening. As I read the article I started to realize that sepsis is major problem being experienced by many people in hospital. It has also been associated with high rates of morbidity and mortality for centuries.
It is important for many people in the healthcare industry that includes nurses and doctors to look for signs of sepsis in patients before it’s too late and to reduce the high rate of morbidity and mortality. The authors explain that early detection is important to providing opportunities for successful intervention. Information found in the article stated that “sepsis is a Life threatening organ dysfunction caused by a dysregulated host response to infection”. And if not treated can lead to septic shock which can be defined as Sepsis with a requirement for vasoactive therapy to maintain mean arterial pressure ≥65 mm Hg and lactate elevation to >2 mmol/L despite adequate volume resuscitation”(Poston, Koyner 2019).
The authors’ give great details on the care that is associated with those patients that are suffering from sepsis. Medical treatment being resuscitation, supportive care being the Early administration of appropriate antibiotics, Achieve control or removal of source of infection, using the best practice strategies for patients with sepsis, vasoactive drugs and renal replacement therapy these treatments can help reduce the risk of death in people suffering from sepsis and sepsis related shock. These treatments can help reduce the morbidity and mortality rate of patients experiencing sepsis.
To conclude the authors’ article on sepsis was relevant as there are a lot of people who are suffering from acute kidney injury and even end stage renal disease it gives insight to how important taking care of our body is. Sepsis is life threatening can be reduced it remains a common and highly morbid complication of a common critical illness which is acute kidney injury. The authors conclude the article by stating” vigilance for risk factors for SA-AKI risks is essential so that preventive strategies may be implemented”. However I would have liked to read more on how the implementation of the treatments affected those who have experienced sepsis associated kidney injury.
Poston, J., & Koyner, J. (2019). Septic associated acute kidney injury. BMJ: British American Journal, doi: https://doi.org/10.1136/bmj.k4891
Competing interests: No competing interests
Current consensus definitions of acute kidney injury (AKI) are based on correlates of renal function, namely serum creatinine levels and measurement of urine output. Therefore by definition, on clinical diagnosis of AKI, the kidney is already functionally impaired by the original insult(s). Biomarkers of AKI offer a putative opportunity to identify the “at risk” kidney in the variable window of time between insult and functional impairment.
A biomarker that is highlighted in this review paper is NGAL (neutrophil gelatinase-associated lipocalin). Within hospitals in the United Kingdom, neither serum nor urinary NGAL are used clinically as a biomarker of early acute kidney injury. The most recent National Institute for Health and Care Excellence (NICE) guidelines for the detection of AKI still focus on the use of serum creatinine and urine output measures. Cost-effectiveness data suggests that the use of NGAL may be financially viable, with estimates of £24 per urinary NGAL test, although a lack of clinical studies mean that it is not clear whether routine urinary NGAL measurements provide any clinical benefit over current AKI diagnostic methods (1). Urinary NGAL has however proven to be useful in experimental ex vivo normothermic perfusion studies of declined kidneys in the context of renal transplantation (2).
1. NICE Medtech innovation briefing - The NGAL Test for early diagnosis of acute kidney injury (2014) [Online] https://www.nice.org.uk/advice/mib3/resources/the-ngal-test-for-early-di... [Accessed February 2019]
2. Hosgood SA, Nicholson ML. An assessment of Urinary Biomarkers in a Series of Declined Human Kidneys Measured During Ex Vivo Normothermic Kidney Perfusion. Transplantation. 2017 Sep; 101(9): 2120-2125.
Competing interests: No competing interests