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Renal recovery

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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.

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Abbreviations

AKD:

Acute kidney disease

AKI:

Acute kidney injury

ATN:

Acute renal failure trial network

AUC:

Area under the curve

CI:

Confidence interval

CKD:

Chronic kidney disease

CRRT:

Continuous renal replacement therapy

GFR:

Glomerular filtration rate

IRRT:

Intermittent renal replacement therapy

KDIGO:

Kidney disease improving global outcomes

KIM-1:

Kidney injury molecule-1

NGAL:

Neutrophil gelatinase-associated lipocalin

RIFLE:

Risk, injury, failure, loss, end-stage kidney disease

RR:

Relative risk

RRT:

Renal replacement therapy

SOFA:

Sequential organ failure assessment

SOI:

Severity of illness.

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Authors and Affiliations

  1. Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 45229, USA

    Stuart L Goldstein

  2. Department of Anesthesiology and Critical Care Medicine, George Washington University Medical Center, Washington DC Division of Renal Diseases and Hypertension, Washington, DC, 20037, USA

    Lakhmir Chawla

  3. Department of Medicine, George Washington University Medical Center, Washington,DC, 20037, USA

    Lakhmir Chawla

  4. Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute, San Bortolo Hospital, Vicenza, 36100, Italy

    Claudio Ronco

  5. Center for Critical Care Nephrology, CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, Pittsburgh, PA, 15621, USA

    John A Kellum

  6. Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15621, USA

    John A Kellum

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  1. Stuart L Goldstein
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  2. Lakhmir Chawla
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  3. Claudio Ronco
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  4. John A Kellum
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Correspondence to John A Kellum.

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Goldstein, S.L., Chawla, L., Ronco, C. et al. Renal recovery. Crit Care 18, 301 (2014). https://doi.org/10.1186/cc13180

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