Acute Renal Failure in Sepsis
Dr. Michael Fernando (CA-2) did an excellent presentation of Acute Renal Failure and Sepsis featured in the July 2004 New England Journal of Medicine. With the significant morbidity and mortality associated with sepsis, septic shock and acute renal failure it is prudent to understand the mechanisms of this disease process as well as evaluate which interventions make therapeutic sense! This review in NEJM gives us some insight and may help intensivists answer some of these questions. This is archived in the collection of Journal Club Presentations.
It was identified that early sepsis maybe a state in which physiologically the body is depleted of vasopressin because the hypothalamic stores empty fast hence theoretically it makes sense to proceed with AVP infusions early in sepsis, however, there are poor outcome studies out there to show any therapeutic benefit. Early goal directed therapy (Rivers et al) may be of some benefit as mortality rates were improved ~16% however these studies are also flawed with biases and a baseline high mortality rate which is of concern. The data on “tight” glycemic control shows that mortality rates were cut in half in post-cardiac surgery patients as well as a 41% reduction in incidence of ARF – but why were they on TPN on day 1 post-op? These are some of the issues raised in this review along with steroid therapy and frequency of RRT.
