What is Sepsis-Induced Acute Kidney Failure?

Sepsis-induced acute kidney failure is a type of emergency that occurs upon the sudden ceasing of normal functioning of the kidneys because of sepsis, which is the life-threatening response to infection resulting in systemic inflammation, low blood pressure, and impairment of blood flow to organs.

Sepsis-induced acute kidney injury refers to the halting of normal kidney function during which the kidneys fail to filter waste, maintain fluid balance, or regulate electrolytes, usually within hours to days. It is a condition commonly seen in critically ill patients. If unattended, it turns into a significant threat to survival or morbidity.

Symptoms & Causes

Sepsis-induced acute kidney failure often has symptoms that would overlap with the symptoms of sepsis itself and kidney dysfunction:-

General Symptoms of Sepsis

High fever or low body temperature
Rapid heart rate
Quick breaths
Confusion or disorientation
Shivering or feeling very cold
Extreme fatigue

Symptoms of Kidney Failure

Oliguria (decreased urine output)
Swelling in the legs, ankles, or around the eyes
Shortness of breath
Nausea or vomiting
Flank pain (lower back near the kidneys)
Fluid retention and high blood pressure

In cases of deadly sepsis, the patient might go into septic shock and need intensive care.

Causes

Sepsis-induced AKI was primarily related to the interplay of infection, inflammation, and reduced blood flow. The classical ones are:-

Bacterial infection (most common): lungs (pneumonia), urinary tract, abdomen, bloodstream
Fungus or, rarely, a virus infection
Hospital-acquired infections amongst vulnerable individuals
Complications or invasive procedures

Mechanisms of sepsis-induced injury to the kidneys:-

Low blood flow to the kidney due to low blood pressure
Inflammatory damage to the kidney tissues
Microvascular dysfunction affects oxygen and nutrient supply
Bacterial toxins damage kidney cells

Diagnosis & Tests

The prime factor to avoid irreversible kidney damage or death, however, is timely and correct diagnosis. The diagnostic work-up involves:-

1. Blood tests

Serum Creatinine and BUN (Blood Urea Nitrogen): antibiotic treatment remains continued until high values become noticeable, indicating kidney dysfunction
EGFR (estimated Glomerular Filtration Rate): This shows how well the kidney filters urine.
Lactate levels: sepsis with insufficient oxygen delivery.
Complete Count of Blood (CBC): check for infection and inflammation.
Electrolyte panel: detecting imbalances in potassium, sodium, calcium, etc.

2. Urine Tests

Urinalysis: for signs of protein, blood, or abnormal cells.
Monitoring urine output: low output is an essential sign of acute kidney injury.

3. Imaging Tests

Ultrasound or CT: size, obstruction, or other abnormalities of the kidneys.

4. Blood culture & Identification of the Organism

Identifying the infection source and an appropriate choice of antibiotics.

Management & Treatment

These are aimed at eradicating the infection, ensuring the functioning of the kidneys and preventing further complications. Generally, hospitalisation is required; in severe cases, they need treatment in an intensive-care unit.

1. Infection Control

A broad-spectrum antibiotic is urgently needed and modifiable depending on the culture results.
Control from the source of an infection, such as abscess drainage or removal of infected catheters.

2. Supportive Care for the Kidneys

IV fluids to maintain blood pressure and kidney perfusion.
Vasopressors to increase blood pressure in septic shock.
Avoid nephrotoxic drugs (e.g., NSAIDs, contrast dyes).

3. Dialysis: Renal replacement therapy

Dialysis is the best option if kidney function worsens for reasons such as the following:-

To remove waste products and toxins
For fluid balance
To regulate electrolytes

Types of Dialysis Used:-

Intermittent Hemodialysis
Continuous Renal Replacement Therapy (CRRT) – preferred in unstable ICU patients

4. Nutritional & Electrolyte Management

With nutrition and electrolytes
Meticulous monitoring of potassium, calcium, and bicarbonate levels

Prognosis

Prognosis for sepsis-induced acute kidney failure depends on:-

Severity of sepsis
Age and general health of the patient
Speed diagnosis treatment
Requirement of dialysis

Key Points:

High mortality is exceptionally high in patients with multi-organ failure or when doctors control the conditions a little too late.
Some patients recover completely with early intervention.
Others, however, may end up with chronic kidney disease (CKD) and may require prolonged dialysis.
Survivors often require long rehabilitation followed by a follow-up.

Prevention

Another intervention can tip the scales of this disorder toward lesser risk:-

Mainly, those infections are detected and treated as early as possible.
Vaccination (e.g., flu and pneumococcus) for at-risk populations.
A guide to hospital hygiene and infection control.
Prompt treatment of infections affecting the elderly or chronically ill.
Avoid the introduction of catheters and other invasive devices unless necessary.
Performing routine renal function assessment for patients with sepsis or being treated for critical illness.

Living With

Recovery from sepsis-induced AKI takes weeks to months. Considerations for the long term would be:-

Monitoring Renal Function
- Regular eGFR and creatinine, blood, and urine tests.
- Early referral to a nephrologist in the event of the development of CKD.
Changes in Lifestyle
- Salt and protein restrictions (if recommended).
- Tight control of blood pressure & glucose levels in the blood.
- Avoid the use of nephrotoxic drugs as much as possible.
- Only physicians recommend Hydration.
Psychiatric and Physical Rehabilitation
- Post-ICU fatigue, anxiety, and depression are widespread.
- Family support, counselling, and therapy will all enhance recovery.
Recurrent Risks
- Already having sepsis and an acute kidney injury makes the patient prone to a higher risk of kidney events in the future.
- Awareness and prevention have to be the key here.

Is kidney failure from sepsis reversible?

It can be especially true if the doctor institutes treatment earlier. Many patients regain normal or nearly normal function. However, some may have long-term complications.

When do kidneys fail in sepsis?

Kidney failure can happen from hours to days after the start of sepsis; hence, any delay can endanger life.

Can sepsis permanently damage the kidneys?

Yes. Severe or unremitting AKI may lead to CKD or end-stage renal disease, requiring lifelong dialysis.

Who is at risk of sepsis-induced AKI?

The elderly, diabetics, ICU patients, immunocompromised persons, or those with pre-existing renal impairment are more predisposed.

Where does dialysis fit into this condition?

Dialysis removes waste and excess fluid when the kidneys are temporarily or permanently unable to function. It's often life-saving in these instances.

Why Choose Tender Palm Hospital for Sepsis-Induced Acute Kidney Failure treatment in Lucknow, India?

Tender Palm Super-Speciality Hospital has the most trusted team of Nephrologists with advanced diagnostic equipment care for Sepsis-Induced Acute Kidney Failure treatment in Lucknow, India. Our Nephrology department follows international safety standards and has years of experience in successfully managing disease and conditions like Sepsis-Induced Acute Kidney Failure.