Acute kidney injury (AKI) in the intensive care unit (ICU) is a heterogeneous syndrome characterized by kidney stress, structural injury, functional decline, requirement for extracorporeal organ support, and incomplete recovery, rather than a single creatinine-defined event. Current critical care practice increasingly integrates conventional Kidney Disease: Improving Global Outcomes (KDIGO) diagnostic criteria with urine output trajectories, cystatin C measurement when serum creatinine is unreliable, structural damage biomarkers when results will change management, hemodynamic phenotyping, venous congestion assessment, nephrotoxin stewardship, fluid stewardship, and recovery planning. This narrative review summarizes recent advances relevant to adult ICU care, including evolving definitions of AKI and acute kidney disease, sepsis-associated microcirculatory and cellular injury, systemic venous congestion, point-of-care ultrasound-assisted congestion assessment, biomarker-triggered prevention bundles, individualized renal replacement therapy (RRT), continuous renal replacement therapy (CRRT), and post-ICU recovery pathways. Key recommendations include avoiding automatic fluid loading in response to oliguria; interpreting mean arterial pressure together with cardiac output, central venous pressure, right ventricular function, and intra-abdominal pressure; using biomarkers only within an actionable response pathway; and initiating RRT according to urgent or trajectory-based indications rather than serum creatinine alone. Precision ICU nephrology is best conceptualized as the timely alignment of phenotype, risk, trajectory, and organ support objectives.
Abstract
Journal Article
Review
eng
42375913
Mahmoud, Ibrahim Fadl, et al. "Acute Kidney Injury in the Intensive Care Unit: Recent Advances." Cureus, vol. 18, no. 5, 2026, pp. e109927.
Mahmoud IF, Erwi SM, Alfageeh AM. Acute Kidney Injury in the Intensive Care Unit: Recent Advances. Cureus. 2026;18(5):e109927.
Mahmoud, I. F., Erwi, S. M., & Alfageeh, A. M. (2026). Acute Kidney Injury in the Intensive Care Unit: Recent Advances. Cureus, 18(5), e109927. https://doi.org/10.7759/cureus.109927
Mahmoud IF, Erwi SM, Alfageeh AM. Acute Kidney Injury in the Intensive Care Unit: Recent Advances. Cureus. 2026;18(5):e109927. PubMed PMID: 42375913.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR
T1 - Acute Kidney Injury in the Intensive Care Unit: Recent Advances.
AU - Mahmoud,Ibrahim Fadl,
AU - Erwi,Saud M,
AU - Alfageeh,Ali M,
Y1 - 2026/05/30/
PY - 2026/05/29/accepted
PY - 2026/6/30/medline
PY - 2026/6/30/pubmed
PY - 2026/6/30/entrez
KW - acute kidney injury
KW - biomarkers
KW - critical care nephrology
KW - fluid stewardship
KW - intensive care unit
KW - renal replacement therapy
KW - venous congestion
SP - e109927
EP - e109927
JF - Cureus
JO - Cureus
VL - 18
IS - 5
N2 - Acute kidney injury (AKI) in the intensive care unit (ICU) is a heterogeneous syndrome characterized by kidney stress, structural injury, functional decline, requirement for extracorporeal organ support, and incomplete recovery, rather than a single creatinine-defined event. Current critical care practice increasingly integrates conventional Kidney Disease: Improving Global Outcomes (KDIGO) diagnostic criteria with urine output trajectories, cystatin C measurement when serum creatinine is unreliable, structural damage biomarkers when results will change management, hemodynamic phenotyping, venous congestion assessment, nephrotoxin stewardship, fluid stewardship, and recovery planning. This narrative review summarizes recent advances relevant to adult ICU care, including evolving definitions of AKI and acute kidney disease, sepsis-associated microcirculatory and cellular injury, systemic venous congestion, point-of-care ultrasound-assisted congestion assessment, biomarker-triggered prevention bundles, individualized renal replacement therapy (RRT), continuous renal replacement therapy (CRRT), and post-ICU recovery pathways. Key recommendations include avoiding automatic fluid loading in response to oliguria; interpreting mean arterial pressure together with cardiac output, central venous pressure, right ventricular function, and intra-abdominal pressure; using biomarkers only within an actionable response pathway; and initiating RRT according to urgent or trajectory-based indications rather than serum creatinine alone. Precision ICU nephrology is best conceptualized as the timely alignment of phenotype, risk, trajectory, and organ support objectives.
SN - 2168-8184
UR - https://www.unboundmedicine.com/prime/citation/42375913/Acute_Kidney_Injury_in_the_Intensive_Care_Unit:_Recent_Advances.
DB - PRIME
DP - Unbound Medicine
ER -
