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Acute Kidney Injury at the Neurocritical Care Unit

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Abstract

Neurocritical care has advanced substantially in recent decades, allowing doctors to treat patients with more complicated conditions who require a multidisciplinary approach to achieve better clinical outcomes. In neurocritical patients, nonneurological complications such as acute kidney injury (AKI) are independent predictors of worse clinical outcomes. Different research groups have reported an AKI incidence of 11.6% and an incidence of stage 3 AKI, according to the Kidney Disease: Improving Global Outcomes, that requires dialysis of 3% to 12% in neurocritical patients. These patients tend to be younger, have less comorbidity, and have a different risk profile, given the diagnostic and therapeutic procedures they undergo. Trauma-induced AKI, sepsis, sympathetic overstimulation, tubular epitheliopathy, hyperchloremia, use of nephrotoxic drugs, and renal hypoperfusion are some of the causes of AKI in neurocritical patients. AKI is the result of a sum of events, although the mechanisms underlying many of them remain uncertain; however, two important causes that merit mention are direct alteration of the physiological brain–kidney connection and exposure to injury as a result of the specific medical management and well-established therapies that neurocritical patients are subjected to. This review will focus on AKI in neurocritical care patients. Specifically, it will discuss its epidemiology, causes, associated mechanisms, and relationship to the brain–kidney axis. Additionally, the use and risks of extracorporeal therapies in this group of patients will be reviewed.

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Acknowledgements

The authors thank Anita Zurita Poza for her excellent technical assistance. GRG thanks Biorender for the design of the figures.

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Authors and Affiliations

  1. Critical Care Unit, Carlos Van Buren Hospital, Valparaíso, Chile

    Gonzalo Ramírez-Guerrero & Romyna Baghetti-Hernández

  2. Dialysis and Renal Transplant Unit, Carlos Van Buren Hospital, Valparaíso, Chile

    Gonzalo Ramírez-Guerrero

  3. Deparment of Medicine, Universidad de Valparaíso, Valparaíso, Chile

    Gonzalo Ramírez-Guerrero & Romyna Baghetti-Hernández

  4. Department of Medicine, Università di Padova, Padua, Italy

    Claudio Ronco

  5. Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy

    Claudio Ronco

  6. International Renal Research Institute of Vicenza, Vicenza, Italy

    Claudio Ronco

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  1. Gonzalo Ramírez-Guerrero
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GRG, RBH designed the work, GRG, RBH collected and analyzed the data, GRG, RBH, and CR drafted the work or substantively revised it, and all authors read and approved the final manuscript.

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Ramírez-Guerrero, G., Baghetti-Hernández, R. & Ronco, C. Acute Kidney Injury at the Neurocritical Care Unit. Neurocrit Care 36, 640–649 (2022). https://doi.org/10.1007/s12028-021-01345-7

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