Renal Problems in Neurocritical Care

The brain and kidney share an intimate relationship at anatomical and physiological levels, both in health and diseased states. An injured brain has the potential to disrupt normal renal functioning, leading to an acute derangement in its function, termed broadly as acute kidney injury (AKI). AKI, in turn, is a multisystemic disease associated with multitude of extrarenal complications and high morbidity and mortality in neurocritically ill patients. In the absence of a single therapeutic modality, the successful treatment of AKI is dependent on the individualization of treatment. Damage biomarker guided implementation of a bundle based on the supportive care including discontinuation of nephrotoxins, hemodynamic optimization, avoidance of hyperglycemia, and early enteral nutrition may help to reduce the incidence of AKI. Renal replacement therapies need appropriate modifications to minimize their associated complications in neurocritically ill patients. Though none of the techniques show superiority over others in terms of mortality benefits, continuous therapies may edge over intermittent dialysis in neurocritical patients. Artificial intelligence and precision medicine appear promising as early prediction tools and to improve the prognosis of this subset of patients.