What are the hemodynamic objectives for the kidney in septic shock?

Abstract

Acute renal failure is a common complication in septic shock (30 to 70% of the patients) and is associated with high mortality (50% at 3 months). Although not representing the only involved mechanism, the hemodynamic component plays probably a major role in the development and maintenance of kidney injury. The aim of this review is to discuss the hemodynamic objectives in order to preserve kidney function in sepsis. A comprehensive analysis of experimental and clinical studies is necessary to better understand this complex issue. Animal model-based investigations remain inconclusive about renal blood flow changes in sepsis. However, cardiac output seems to be a major determinant. Data on renal microcirculation are limited but provide many interesting opportunities. Clinical studies suggest that prevention of renal failure in sepsis would require as early as possible to maintain mean arterial pressure beyond the level of the usual recommendations, at least in certain clinical conditions.