Infection Post-AKI: Should We Worry?

Acute kidney injury (AKI) continues to be a major problem among hospitalized patients, and there is a growing appreciation that the high mortality in AKI may be due to its deleterious systemic effects. Recent research has begun to disentangle kidney-organ cross talk, wherein the host response to AKI becomes maladaptive, resulting in effects on numerous remote organs such as the lung, heart, liver, spleen, and brain. AKI also adversely affects immune function and is widely considered an immunosuppressed state. A wealth of data has accumulated that patients with AKI have a substantial increased risk of subsequent infection and sepsis. Indeed, sepsis is the leading cause of death in patients with established AKI. Unfortunately, little is known regarding the nature of the abnormal immune response that increases the risk for septic complications which may be persistent and prolonged. Until mechanistic pathways that drive the AKI-immune system-infection process are identified, and physicians should attempt to minimize AKI, its severity, and duration and anticipate infectious complications.