الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Septicemia is a state of microbial invasion from a portal of entry into the blood stream which causes sign of illness.
• Infection is a microbial phenomenon in which an inflammatory response to the presence of microorganisms or the invasion of normally sterile host tissue by these organisms is characteristic.
• Bacteremia is the presence of viable bacteria in the blood.
• Systemic inflammatory response syndrome (SIRS) may follow a variety of clinical insults, including infection, pancreatitis, ischemia, multiple trauma, tissue injury, hemorrhagic shock, or immune-mediated organ injury.
• Sepsis is a systemic response to infection. This is identical to SIRS, except that it must result from infection.
• Septic shock is sepsis with hypotension (systolic BP < 90 mm Hg or a reduction of 40 mm Hg from baseline) despite adequate fluid resuscitation. Concomitant organ dysfunction or perfusion abnormalities (eg, lactic acidosis, oliguria, coma) are present in the absence of other known causes.
• People whose immune systems (the body’s defense against microbes) are not functioning well because of an illness (such as diabetes or AIDS) or because of medical treatments (such as chemotherapy for cancer or steroids for a number of medical conditions) that weaken the immune system are more prone to develop sepsis. It is important to remember that even healthy people can become septic.
Organ dysfunction or organ failure may be the first clinical sign of sepsis,(plumonary, GIT, CNS & renal dysfunction) and no organ system is immune from the consequences of the inflammatory excesses of sepsis. Mortality rates increase with the increase of failed organs.
Acute kidney injury (AKI), previously called acute renal failure (ARF) is a rapid loss of kidney function. Its causes are numerous and include low blood volume from any cause, exposure to substances harmful to the kidney, and obstruction of the urinary tract. AKI is diagnosed on the basis of characteristic laboratory findings, such as elevated blood urea nitrogen and creatinine, or inability of the kidneys to produce sufficient amounts of urine. AKI may lead to a number of complications, including metabolic acidosis, high potassium levels, uremia, changes in body fluid balance, and effects to other organ systems. Management includes supportive care, such as renal replacement therapy, as well as treatment of the underlying disorder.
AKI may be classified into 3 general categories, as follows:
• Prerenal - as an adaptive response to severe volume depletion and hypotension, with structurally intact nephrons
• Intrinsic - in response to cytotoxic, ischemic, or inflammatory insults to the kidney, with structural and functional damage
• Postrenal - from obstruction to the passage of urine
The prognosis for patients with AKI is directly related to the cause of renal failure and, to a great extent, to the duration of renal failure prior to therapeutic intervention.
Other prognostic factors include the following:
• Older age
• Multiorgan failure (ie, the more organs that fail, the worse the prognosis)
• Oliguria
• Hypotension
• Vasopressor support
• Number of transfusions
• Noncavitary surgery
The first priority in any patient with severe sepsis or septic shock is stabilization of their airway and breathing. Next, perfusion to the peripheral tissues should be restored Stabilize respiration — Supplemental oxygen should be supplied to all patients with sepsis and oxygenation should be monitored continuously with pulse oximetry. Intubation and mechanical ventilation may be required to support the increased work of breathing that typically accompanies sepsis, or for airway protection since encephalopathy and a depressed level of consciousness frequently complicate sepsis.
Indications for dialysis in patients with AKI are as follows:
• Volume expansion that cannot be managed with diuretics
• Hyperkalemia refractory to medical therapy
• Correction of severe acid-base disturbances that are refractory to medical therapy
• Uremia. (200 mg/dl or more)
The overall incidence of AKI is difficult to assess and varies among different study populations in developing countries, with an overall range from 1 to 25% in critically ill patients.
The Beginning and Ending Supportive Therapy for the Kidney (BEST) study investigated the incidence of acute renal failure on an international scale among 29,629 patients from 54 centers in 23 countries
The prevalence of AKI requiring renal replacement therapy (RRT) was approximately 4% and hospital mortality in these patients was approximately 60%, which is similar to numerous other studies. Data collection was limited to 28 days, and information was not obtained.
Conclusion
- Considerable partition of patients developed ARF early during the course of sepsis, and most of them needed Renal Replacement Therapy (RRT).
- There is strong relationship between sepsis and RF which is considered one of the most dangerous complications of sepsis.
- High mortalitiy rates associated with sepsis combined with RF than with sepsis alone.
- Even with optimal treatment, mortality due to severe sepsis or septic shock is approximately 40 percent and can exceed 50 percent in the sickest patients
- It is important to remember that the prognosis also depends on any delay in diagnosis and treatment. The earlier the treatment is started, the better the outcome will be