Acute kidney injury and disease: Long‐term consequences and management

Abstract

With increasing longevity and the presence of multiple comorbidities, a significant proportion of hospitalized patients, and an even larger population in the community, is at increased risk of developing an episode of acute kidney injury (AKI). Because of improvements in short-term outcomes following an episode of AKI, survivors of an episode of AKI are now predisposed to develop its long-term sequel. The identification of risk for progression to chronic kidney disease (CKD) is complicated by the absence of good biomarkers that identify this risk and the variability of risk associated with clinical factors including, but not limited to, the number of AKI episodes, severity, duration of previous AKI and pre-existing CKD that has made the prediction for long-term outcomes in survivors of AKI more difficult. Being a significant contributor to the growing incidence of CKD, there is a need to implement measures to prevent AKI in both the community and hospital settings, target interventions to treat AKI that are also associated with better long-term outcomes, accurately identify patients at risk of adverse consequences following an episode of AKI and institute therapeutic strategies to improve these long-term outcomes. We discuss the lasting renal and non-renal consequences following an episode of AKI, available biomarkers and non-invasive testing to identify ongoing intra-renal pathology and review the currently available and future treatment strategies to help reduce these adverse long-term outcomes.

Biomarkers of acute kidney injury and their role in clinical patient management

“…Patients who have survived the AKI episode; face increased risk of death, cardiovascular event, hypertension, CKD, stroke and decreased quality of life in the long term. Advanced age and comorbid diseases increase the rate of these effects (165). Patients should be checked for 3-6 month periods due to possible complications and risk of CKD.…”

Adapting the Escape Room to Engage Learners Two Ways During COVID-19

“…When creating the project, "An Escape Room Simulation Focused on Renal-Impairment for Prelicensure Nursing Students" [1] the author's goal was to increase positive health outcomes for patients with acute kidney injury (AKI). AKI is complicated, but nurses who can help identify those at risk for the disorder and help initiate early treatment can improve patients' results [2][3][4][5]. This paper focuses on how the original escape room idea, created out of a need to engage learners and grow their clinical judgment, evolved to support nursing education needs during the COVID pandemic of 2020.…”

Changes in Novel AKI Biomarkers after Exercise. A Systematic Review

“…Repeated episodes of acute kidney failure may lead to chronic kidney disease (CKD); therefore, proper diagnosis of AKI is important [ 14 ]. There is no evidence that sport practicing can lead to chronic kidney problems; nevertheless, after marathon run and other endurance events, an acute renal failure requiring renal replacement therapy was observed [ 15 ].…”

“…Repeated episodes of acute kidney failure may lead to chronic kidney disease (CKD); therefore, proper diagnosis of AKI is important [ 14 ]. There is no evidence that sport practicing can lead to chronic kidney problems; nevertheless, after marathon run and other endurance events, an acute renal failure requiring renal replacement therapy was observed [ 15 ]. The possible factors causing post-exercise AKI are dehydration, sub-clinical rhabdomyolysis, inflammation, increased energy demanding renal sodium uptake, reduced renal perfusion and nonsteroidal anti-inflammatory drugs (NSAIDs) frequently used by runners [ 16 , 17 ].…”