Prevention, detection and management of acute kidney injury: concise guideline

Ftouh, Saoussen; Lewington, Andrew

doi:10.7861/clinmedicine.14-1-61

Cited by 34 publications

(18 citation statements)

References 8 publications

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“…Acute kidney injury (AKI) affects an estimated 13–18% of hospitalised patients, 1 frequently under the care of specialties other than nephrology. With the advent of an internationally agreed definition based on changes in serum creatinine and urine output, 2 there is now increasing awareness of the poor outcomes suffered by such patients and this has been accompanied by an emphasis on early detection in an effort to improve patient safety and outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…With the advent of an internationally agreed definition based on changes in serum creatinine and urine output, 2 there is now increasing awareness of the poor outcomes suffered by such patients and this has been accompanied by an emphasis on early detection in an effort to improve patient safety and outcomes. 1 Some of the poor outcomes (including increased mortality 2 3 and development of chronic kidney disease (CKD) 4–6 ) are increasingly described after hospital discharge, but this is variable and factors associated with long-term prognosis are poorly understood. 1 Recent guidelines from the National Institute for Health and Care Excellence (NICE) call for more studies into AKI, with non-AKI comparators, but without specifying which factors should be included in study design.…”

Section: Introductionmentioning

confidence: 99%

“… 1 Some of the poor outcomes (including increased mortality 2 3 and development of chronic kidney disease (CKD) 4–6 ) are increasingly described after hospital discharge, but this is variable and factors associated with long-term prognosis are poorly understood. 1 Recent guidelines from the National Institute for Health and Care Excellence (NICE) call for more studies into AKI, with non-AKI comparators, but without specifying which factors should be included in study design.…”

Section: Introductionmentioning

confidence: 99%

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Long-term prognosis after acute kidney injury (AKI): what is the role of baseline kidney function and recovery? A systematic review

et al. 2015

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ObjectivesTo summarise the evidence from studies of acute kidney injury (AKI) with regard to the effect of pre-AKI renal function and post-AKI renal function recovery on long-term mortality and renal outcomes, and to assess whether these factors should be taken into account in future prognostic studies.Design/SettingA systematic review of observational studies listed in Medline and EMBASE from 1990 to October 2012.ParticipantsAll AKI studies in adults with data on baseline kidney function to identify AKI; with outcomes either stratified by pre-AKI and/or post-AKI kidney function, or described by the timing of the outcomes.OutcomesLong-term mortality and worsening chronic kidney disease (CKD).ResultsOf 7385 citations, few studies met inclusion criteria, reported baseline kidney function and stratified by pre-AKI or post-AKI function. For mortality outcomes, three studies compared patients by pre-AKI renal function and six by post-AKI function. For CKD outcomes, two studies compared patients by pre-AKI function and two by post-AKI function. The presence of CKD pre-AKI (compared with AKI alone) was associated with doubling of mortality and a fourfold to fivefold increase in CKD outcomes. Non-recovery of kidney function was associated with greater mortality and CKD outcomes in some studies, but findings were inconsistent varying with study design. Two studies also reported that risk of poor outcome reduced over time post-AKI. Meta-analysis was precluded by variations in definitions for AKI, CKD and recovery.ConclusionsThe long-term prognosis after AKI varies depending on cause and clinical setting, but it may also, in part, be explained by underlying pre-AKI and post-AKI renal function rather than the AKI episode itself. While carefully considered in clinical practice, few studies address these factors and with inconsistent study design. Future AKI studies should report pre-AKI and post-AKI function consistently as additional factors that may modify AKI prognosis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-term prognosis after acute kidney injury (AKI): what is the role of baseline kidney function and recovery? A systematic review

et al. 2015

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“…[7][8][9] Respiratory distress and encephalitis are the principal cause of death in patients with severe disease. 10 Acute kidney injury (AKI) is a major global health issue and its incidence is markedly rising 11 and affects an estimated 13-18% of hospitalised patients, 12 resulting in increasing hospital stay, healthcare costs, poor short-term and long-term outcomes, 13 especially in patients with chronic kidney disease (CKD). 14 In patients with infectious disease, especially those with sepsis, the incidence of AKI is reported to range from 5% to 51%.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Incidence, risk factors and clinical outcomes of acute kidney injury associated with scrub typhus: a retrospective study of 510 consecutive patients in South Korea (2001–2013)

et al. 2017

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ObjectivesRenal involvement in scrub typhus ranges from simple urinary abnormalities to acute kidney injury (AKI) leading to death. This study evaluated the incidence, predictors and prognosis of AKI associated with scrub typhus according to the RIFLE (risk, injury, failure, loss, end-stage kidney disease) criteria.MethodsWe retrospectively evaluated the medical records of patients diagnosed with scrub typhus from January 2001 to November 2013 in Gyeongsang National University Hospital.ResultsDuring the study period, 510 patients were diagnosed with scrub typhus and the incidence of AKI was 35.9%. There were 132 (25.9%) patients at risk, 37 (7.3%) with injury and 14 (2.7%) with failure. In comparison with the non-AKI group, the AKI group was older (73.9 vs 63.4 years, p<0.001) and had more comorbidities such as hypertension, diabetes mellitus and chronic kidney disease (CKD). AKI frequently occurs in hypertensive patients taking angiotensin receptor blockers or ACE inhibitors (p=0.002), and in patients with diabetes with higher glycated haemoglobin levels (p=0.033). Haematuria and proteinuria were more frequent in the AKI group. There was no relationship between the severity of proteinuria and occurrence of AKI. Intensive care unit admission and death were more frequent in the AKI group. The renal function of most patients with AKI recovered without sequelae, except for 1 patient who had underlying CKD. Multivariate analysis showed that age, presence of CKD, serum albumin level and time to hospital presentation after symptom onset were independent predictors of AKI in patients with scrub typhus.ConclusionsOur current results suggest that the presence of underlying CKD, older age, lower serum albumin level and time to hospital presentation after symptom onset were important risk factors to determine occurrence of AKI. Whether earlier diagnosis and treatment in patients with the above risk factors reduce the incidence and severity of AKI deserves to be investigated.

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“…General risk factors are age greater than 65 years, heart failure, liver disease, diabetes, chronic kidney disease with or without diabetes, sepsis, urological obstruction, iodinated contrast agents, nephrotoxic medication and hypovolaemia/shock. 13 AKI can be induced by many different events such as rapid blood loss to and from the kidney, vasoconstrictive drugs, exposure to harmful substances, hypotension linked to sepsis, and obstruction of the urinary tract. Table 1 lists the main factors that can lead to AKI, 14 where surgical procedures or medication are often precursors.…”

Section: Introductionmentioning

confidence: 99%

Molecular determinants of acute kidney injury

Husi

Human

2014

J Inj Violence Res

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Abstract:Background:Acute kidney injury (AKI) is a condition that leads to a rapid deterioration of renal function associated with impairment to maintain electrolyte and acid balance, and, if left untreated, ultimately irreversible kidney damage and renal necrosis. There are a number of causes that can trigger AKI, ranging from underlying conditions as well as trauma and surgery. Specifically, the global rise in surgical procedures led to a substantial increase of AKI incidence rates, which in turn impacts on mortality rates, quality of life and economic costs to the healthcare system. However, no effective therapy for AKI exists. Current approaches, such as pharmacological intervention, help in alleviating symptoms in slowing down the progression, but do not prevent or reverse AKI-induced organ damage.Methods:An in-depth understanding of the molecular machinery involved in and modulated by AKI induction and progression is necessary to specifically pharmacologically target key molecules. A major hurdle to devise a successful strategy is the multifactorial and complex nature of the disorder itself, whereby the activation of a number of seemingly independent molecular pathways in the kidney leads to apoptotic and necrotic events. Results:The renin-angiotensin-aldosterone-system (RAAS) axis appears to be a common element, leading to downstream events such as triggers of immune responses via the NFB pathway. Other pathways intricately linked with AKI-induction and progression are the tumor necrosis factor alpha (TNF α) and transforming growth factor beta (TGF β) signaling cascades, as well as a number of other modulators. Surprisingly, it has been shown that the involvement of the glutamatergic axis, believed to be mainly a component of the neurological system, is also a major contributor.Conclusions:Here we address the current understanding of the molecular pathways evoked in AKI, their interplay, and the potential to pharmacologically intervene in the effective prevention and/or progression of AKI.

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Prevention, detection and management of acute kidney injury: concise guideline

Cited by 34 publications

References 8 publications

Long-term prognosis after acute kidney injury (AKI): what is the role of baseline kidney function and recovery? A systematic review

Long-term prognosis after acute kidney injury (AKI): what is the role of baseline kidney function and recovery? A systematic review

Incidence, risk factors and clinical outcomes of acute kidney injury associated with scrub typhus: a retrospective study of 510 consecutive patients in South Korea (2001–2013)

Molecular determinants of acute kidney injury

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