Acute Kidney Injury in NeuroIntensive Care Unit

Neurocritical patients may experience acute kidney injury (AKI), significantly impacting their overall prognosis. The intricate brain-kidney interconnection contributes to the disruption of cerebral homeostasis during kidney injury. Specifically, neuromedical drugs, such as hyperosmolar therapies (mannitol and hypertonic saline), commonly administered to neurocritical patients, have been associated with an increased risk of AKI. Each neurocritical pathology, including traumatic brain injury (TBI), subarachnoid haemorrhage (SAH), and stroke, presents distinct risks and mechanisms for AKI development. Notably, patients undergoing renal replacement therapies in the neuro-intensive care setting require special considerations due to potential neurological consequences, such as cerebral oedema or herniation, adversely affecting cerebral blood flow and intracranial pressure. This article reviews the occurrence of AKI in neuro-intensive care, delving into its definition using standard KDIGO criteria and novel biomarkers. Furthermore, it explores various strategies for diagnosis and preventive measures, emphasizing the importance of avoiding nephrotoxic drugs, optimising hemodynamics, and fluid balance, and outlining management principles.