From the Guidelines
A chest infection can lead to acute renal failure, particularly in cases of severe sepsis or septic shock, with a mortality rate of 70% when both conditions are present 1. This typically occurs through several mechanisms, including decreased blood flow to the kidneys, leading to prerenal acute kidney injury, and the potential nephrotoxic effects of certain antibiotics. Key factors that contribute to the development of acute renal failure in the context of a chest infection include:
- Severe infections triggering systemic inflammatory responses that affect multiple organs, including the kidneys
- Sepsis resulting from a chest infection causing decreased blood flow to the kidneys
- Nephrotoxic effects of certain antibiotics
- Dehydration commonly associated with fever and reduced fluid intake during illness
- Underlying kidney disease or risk factors like diabetes, hypertension, or advanced age In managing patients with a chest infection and risk of acute renal failure, it is crucial to:
- Address the underlying infection with appropriate antibiotics
- Ensure adequate hydration
- Monitor kidney function through blood tests
- Adjust medication dosages to accommodate reduced kidney function when necessary
- Consider the initiation of renal replacement therapy (RRT) in cases of severe acute renal failure, with the choice between intermittent hemodialysis (IHD) and continuous renal replacement therapies (CRRT) being based on individual patient needs and hemodynamic stability 1.
From the Research
Relationship Between Chest Infection and Acute Renal Failure
- A chest infection can lead to sepsis, which is a significant cause of acute kidney injury (AKI) and acute renal failure 2, 3, 4.
- Sepsis-associated AKI is a common complication in critically ill patients, and it can result in increased morbidity and mortality 2, 4.
- The development of AKI in septic patients can be attributed to various factors, including hypovolemia, inflammation, and the use of antimicrobials 3, 5, 6.
Mechanisms and Risk Factors
- The mechanisms of sepsis-associated AKI are complex and involve multiple pathways, including inflammation, oxidative stress, and microvascular dysfunction 2, 4, 5.
- The use of bactericidal antibiotics can temporarily increase inflammation and worsen AKI in experimental sepsis, but it can also lead to faster resolution of inflammation and AKI 6.
- Fluid resuscitation is crucial in the management of septic patients, but it can also have adverse effects on kidney function, including increased risk of AKI and positive fluid balance 5.
Clinical Implications
- The diagnosis and management of sepsis-associated AKI require a multidisciplinary approach, including the use of novel biomarkers, antimicrobials, and fluid resuscitation strategies 2, 3, 4, 5.
- The prevention and treatment of sepsis-associated AKI are challenging, but early detection and intervention can improve outcomes in critically ill patients 2, 4, 5.