Sepsis and the kidney

Acute renal failure (ARF) secondary to sepsis is a highly prevalent diagnosis in the ICU setting and continues to be associated with a high rate of morbidity and mortality. The pathophysiology of sepsis-induced acute renal failure involves ischemic or toxic injury to the renal tubular epithelia, resulting in necrosis or apoptosis, and clinically is characterized as acute tubular necrosis. The management of sepsis-induced ARF includes both conventional intermittent hemodialysis and continuous renal replacement therapies. Experimental therapies to improve outcomes in sepsis-associated ARF include the provision of plasmapheresis and adsorption therapies, and the recent development and deployment of a renal tubule assist device.