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. Author manuscript; available in PMC: 2019 Dec 18.
Published in final edited form as: Kidney Int. 2019 Jun 7;96(5):1083–1099. doi: 10.1016/j.kint.2019.05.026

Figure 1 |. Clinical course and outcomes of sepsis-associated acute kidney injury (S-AKI).

Figure 1 |

The exact onset of kidney injury in sepsis is unknown. Patients who present with sepsis should be suspected for AKI, and, vice versa, those who present with AKI should be suspected for sepsis as well. AKI may present simultaneously with sepsis at hospital admission (a) or develop during hospitalization (b). In the latter case, it is still possible to prevent AKI by optimal resuscitation and appropriate sepsis treatment. Novel biomarkers have an established role in the early recognition of AKI at this point. Once S-AKI is diagnosed, close monitoring and timely organ support should be done together to prevent further kidney injury. However, S-AKI is still associated with an extremely high risk of in-hospital death. The survivors have various clinical trajectories and outcomes. S-AKI is able to reverse early during the first week after being documented and is associated with a good prognosis. Some patients may experience 1 or more episodes of relapse after the initial reversal of AKI during hospitalization. This emphasizes that close monitoring and avoidance of nephrotoxic insults are mandatory along the clinical course of S-AKI even after early reversal or recovery. Patients with complete recovery of S-AKI may be discharged with good health; however, they still carry the risk of chronic kidney disease (CKD) and other consequences, including recurrent sepsis (dotted lines). Those patients who do not completely recover by 7 days after being documented AKI will be classified as having acute kidney disease (AKD), which may recover later or progress to CKD and is associated with adverse long-term outcomes. Further research regarding the potential role of biomarkers for the prediction of renal recovery is needed. S-AKI survivors who are discharged from the hospital should be followed up in the long term with optimal care by a nephrologist to monitor progression to CKD and other long-term consequences. CVD, cardiovascular disease; ED, emergency department.