Renal protection strategies for patients with sepsis in the intensive care department of Fujita Health University

Abstract

Septic acute kidney injury plays a significant role in reducing mortality rates among septic patients requiring ICU admission. Essentially, implementing renoprotective measures in patients with sepsis holds promise for enhancing their general status. Our department’s treatment strategy is characterized by combinations of physiological and pharmacological approaches to preserving renal function. We examine the physiological evidence supporting this strategy, which includes the selection of antimicrobial agents and infusion management, and the utilization of circulatory agonists, diuretics, and blood purification. The core of this strategy is the maintenance of urinary flow and regulation of mediators as needed. Maintaining urinary flow for renal protection is crucial due to the potential tubular obstruction resulting from the filtration of cytokines and other substances from the bloodstream into raw urine, resulting in tubular epithelial damage and a subsequent decline in glomerular filtration rate（GFR）. To maintain urinary flow, our institution strives to maintain urinary flow as much as possible, rather than solely depending on fluid removal through blood purification for water balance. Blood purification is administered with a keen focus on controlling blood and urine mediators, with treatment conditions tailored to the patient’s specific disease status.