The need for disruptive innovation in acute kidney injury

Abstract

Acute kidney injury (AKI) is a threatening medical condition associated with poor outcomes at different settings. The development of standardized diagnostic criteria and new biomarkers addressed significant clinical impacts of AKI and the need for an early AKI detection, respectively. There have been some breakthroughs in understanding the pathogenesis of AKI through basic research; however, treatments against AKI aside from renal replacement therapy (RRT) have not shown adequate successful results. Biomarkers that could identify good responders to certain treatment are expected to facilitate translation of basic research findings. Most patients with severe AKI treated with RRT died due to multiple-organ failure, not renal dysfunction. Hence, it is essential to identify other organ dysfunctions induced by AKI as organ crosstalk. Also, a multidisciplinary approach of critical care nephrology is needed to evaluate a complex organ crosstalk in AKI. For disruptive innovation for AKI, we further explore these new aspects of AKI, which previously were considered outside the scope of nephrology.

Global Perspectives in Acute Kidney Injury: Japan

“…Our government health insurance approves using some biomarkers for AKI detection, including urine neutrophil gelatinase-associated lipocalin (NGAL) and liver-type fatty acid–binding protein. Several published clinical studies from Japan have investigated the clinical significance of such urine biomarkers (21). The AKI guidelines of the JSN also suggest using biomarkers for severity assessment, prognosis prediction, and differential diagnosis of AKI (20).…”

“…Several published clinical studies from Japan have investigated the clinical significance of such urine biomarkers (21). The AKI guidelines of the JSN also suggest using biomarkers for severity assessment, prognosis prediction, and differential diagnosis of AKI (20).…”

Interorgan crosstalk mechanisms in disease: the case of acute kidney injury‐induced remote lung injury

“…Although a number of AKI–ALI mediators have been described, much about their specific sources and lung target cells, as well as molecular mechanisms remains to be discovered. This review builds on and extends a number of excellent previous reviews of AKI–ALI [8,10,37–43]. For an expanded discussion on how AKI and ALI/ARDS interact, taking all clinically relevant physiological effects of AKI in particular reverse effects of ALI or its most severe form acute respiratory distress syndrome (ARDS) onto the kidney into account, the reader is referred to a recent excellent review [44].…”

Biomarkers of acute kidney injury: time to learn from implementations

“…Biomarker thresholds have now been validated in global studies for NGAL 22 and several have been approved and entered regular clinical practice: NGAL in Europe, 23 [TIMP-2]-[IGFBP7] (marketed as NephroCheck, Biomerieux) in the United States 24 and Europe, 25 and liver-type fatty acid-binding protein (L-FABP) in Japan. 26 NephroCheck received approval from the US Food and Drug Administration for early diagnosis and prediction of progression to more severe AKI. 24 These observations suggest that these biomarkers are ready for inclusion in clinical practice.…”