ABSTRACT
Acute kidney injury (AKI) was first described by William Heberden in 1802, and then referred to as ischuria renalis. While the pathophysiology of AKI is complex, alterations in blood flow from volume depletion, hemorrhage, or third-spacing of fluids result in renal hypoperfusion and a decrease in the glomerular filtration rate with preserved, non-ischemic renal parenchyma, a condition termed “pre-renal AKI”. Despite the known high prevalence of AKI in the critically ill patient population, the selection of resuscitative crystalloid fluids remains controversial. Until then, as large confirmatory randomized controlled trials are ongoing, the SMART trial remains a landmark study in that it is the most convincing data available to guide our selection of fluid resuscitation in the critically ill with respect to the risk of the development of AKI. Asanguinous, or crystalloid, fluid resuscitation is now universally utilized in patients with critical illness in the intensive care unit.
