Background: Acute kidney injury (AKI) is an important organ failure, which has an enormous negative impact on outcome in patients with severe sepsis.
Methods: In this paper, the pathophysiological causes as well as noninterventional and interventional (extracorporeal) treatment of patients with AKI and severe sepsis are described.
Results: The cornerstone of noninterventional therapy is infection control and heamodynamic stabilization with fluid resuscitation and vasopressors. In patients with deteriorating AKI, extracorporeal treatment should be started early. Generally, continuous and intermittent modes are considered to be equally effective and possible. In practice, a continuous form is preferred in hemodynamically unstable patients.
Discussion: The idea that AKI may easily be overcome by starting extracorporeal treatment is no longer true. AKI is much more complex. The dynamic process of the disease should be kept in mind when choosing the correct mode and dose of the extracorporeal treatment. Antibiotic dosage must be adjusted when kidney function is improving or deteriorating.