Hoi-Ping Shum, Wing-Wa Yan, Tak Mao Chan; Journal of Critical Care, Published online: September 21 2015
Sepsis is the commonest cause of acute kidney injury (AKI) in critically ill patients. Its pathophysiology is complex and not well understood. Until recently, it was believed that kidney hypoperfusion is the major contributor of septic AKI. However, recent publications have improved our understanding on this topic. We now know that its mechanisms included the following: 1) renal macro- and micro-circulatory disturbance, 2) surge of inflammatory markers and oxidative stress, 3) coagulation cascade activation, and 4) bioenergetics adaptive response with controlled cell cycle arrest aiming to prevent cell death. Uncovering these complicated mechanisms may facilitate the development of more appropriate therapeutic measures in the future.