Renal recovery

Stuart L Goldstein, Lakhmir Chawla, Claudio Ronco, John A Kellum, Stuart L Goldstein, Lakhmir Chawla, Claudio Ronco, John A Kellum

Abstract

Acute kidney injury (AKI) research in the past decade has mostly focused upon development of a standard AKI definition, validation of early novel biomarkers to predict AKI prior to serum creatinine rise and predict AKI severity, and assessment of aspects of renal replacement therapies and their impact on survival. Given the independent association between AKI and mortality in the acute phase, such focus makes imminent sense. More recently, the recognition that AKI is associated with subsequent development of chronic kidney disease and end-stage renal disease, with the attendant increase in mortality, has led to interest in the clinical epidemiology and the mechanistic understanding of renal recovery after an AKI episode in critically ill patients. We review the current knowledge surrounding renal recovery after an AKI episode, including renal replacement therapy initiation timing and modality impact, biomarker assessment and mechanistic targets to guide potential future clinical trials.

Figures

Figure 1
Figure 1
Time periods for renal recovery based on various study endpoints in the published literature. AKD, acute kidney disease [13]; AKI, acute kidney injury; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; RIFLE-E, end-stage of of Risk, Injury, Failure, Loss, End-stage kidney disease criteria [1]; RIFLE-R, loss stage of Risk, Injury, Failure, Loss, End-stage kidney disease criteria; RRT, renal replacement therapy.

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