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Kidney International Dec 1998Acute renal failure is a life threatening illness whose mortality has remained high since the introduction of hemodialysis 25 years ago, despite advances in supportive... (Review)
Review
Acute renal failure is a life threatening illness whose mortality has remained high since the introduction of hemodialysis 25 years ago, despite advances in supportive care. Acute renal failure is an extremely morbid and costly disorder with a significant proportion of patients progressing to end-stage renal disease requiring dialysis. To the nephrologist, acute renal failure remains an extremely frustrating disease, because the pathophysiology is not well understood and the limited therapeutic options force the nephrologist to sit on the sidelines and wait for renal function to return. For example, dialysis remains the only FDA-approved treatment for acute renal failure, but dialysis may also cause renal injury that prolongs renal failure. The purpose of this perspective is to understand the results of the recent, largely negative, clinical trials in view of recent advances in the epidemiology of ARF. This review will also discuss diagnostic tools, strategies for improved design of clinical trials, and other therapeutic interventions that will be needed to properly treat acute renal failure in the 21st century.
Topics: Acute Kidney Injury; Humans; Incidence; Renal Replacement Therapy
PubMed: 9853246
DOI: 10.1046/j.1523-1755.1998.00210.x -
Clinical Chemistry and Laboratory... Jul 2017Acute kidney injury (AKI) is a common complication of critical illnesses and has a significant impact on outcomes, including mortality and morbidities. Unfortunately,... (Review)
Review
Acute kidney injury (AKI) is a common complication of critical illnesses and has a significant impact on outcomes, including mortality and morbidities. Unfortunately, apart from prophylactic measures, no effective treatment for this syndrome is known. Therefore, early recognition of AKI not only can provide better opportunities for preventive interventions, but also opens many gates for research and development of effective therapeutic options. Over the last few years, several new AKI biomarkers have been discovered and validated to improve early detection, differential diagnosis, and differentiation of patients into risk groups for progressive renal failure, need for renal replacement therapy (RRT), or death. These novel AKI biomarkers complement serum creatinine (SCr) and urine output, which are the standard diagnostic tools for AKI detection. In this article, we review the available literature on characteristics of promising AKI biomarkers that are currently the focus of preclinical and clinical investigations. These biomarkers include neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), liver-type fatty acid-binding protein, interleukin 18 (lL-18), insulin-like growth factor-binding protein 7, tissue inhibitor of metalloproteinase 2 (TIMP-2), calprotectin, urine angiotensinogen (AGT), and urine microRNA. We then describe the clinical performance of these biomarkers for diagnosis and prognostication. We also appraise each AKI biomarker's advantages and limitations as a tool for early AKI recognition and prediction of clinical outcomes after AKI. Finally, we review the current and future states of implementation of biomarkers in the clinical practice.
Topics: Acute Kidney Injury; Animals; Biomarkers; Humans; Prognosis
PubMed: 28076311
DOI: 10.1515/cclm-2016-0973 -
Nephrology, Dialysis, Transplantation :... Jul 2014Over the last decade, significant progress has been made in the identification and validation of novel biomarkers as well as refinements in the use of serum creatinine... (Review)
Review
Over the last decade, significant progress has been made in the identification and validation of novel biomarkers as well as refinements in the use of serum creatinine as a marker of kidney function. These advances have taken advantage of laboratory investigations, which have identified these novel molecules that serve important biological functions in the pathogenesis of acute kidney injury (AKI). As we advance and validate these markers for clinical studies in AKI, we recognize that they serve not only to improve our understanding of AKI, but they could also serve as potential targets for the treatment of AKI. This review will underscore the biological basis of specific biomarkers that will contribute to the advancement in the treatment and outcomes of AKI.
Topics: Acute Kidney Injury; Animals; Biomarkers; Humans
PubMed: 24385545
DOI: 10.1093/ndt/gft510 -
International Journal of Molecular... Jun 2019A number of signal transduction pathways are activated during Acute Kidney Injury (AKI). Of particular interest is the Salt Inducible Kinase (SIK) signaling network, and... (Review)
Review
A number of signal transduction pathways are activated during Acute Kidney Injury (AKI). Of particular interest is the Salt Inducible Kinase (SIK) signaling network, and its effects on the Renal Proximal Tubule (RPT), one of the primary targets of injury in AKI. The SIK1 network is activated in the RPT following an increase in intracellular Na (Na), resulting in an increase in Na,K-ATPase activity, in addition to the phosphorylation of Class IIa Histone Deacetylases (HDACs). In addition, activated SIKs repress transcriptional regulation mediated by the interaction between cAMP Regulatory Element Binding Protein (CREB) and CREB Regulated Transcriptional Coactivators (CRTCs). Through their transcriptional effects, members of the SIK family regulate a number of metabolic processes, including such cellular processes regulated during AKI as fatty acid metabolism and mitochondrial biogenesis. SIKs are involved in regulating a number of other cellular events which occur during AKI, including apoptosis, the Epithelial to Mesenchymal Transition (EMT), and cell division. Recently, the different SIK kinase isoforms have emerged as promising drug targets, more than 20 new SIK2 inhibitors and activators having been identified by MALDI-TOF screening assays. Their implementation in the future should prove to be important in such renal disease states as AKI.
Topics: Acute Kidney Injury; Animals; Cyclic AMP Response Element-Binding Protein; Humans; Kidney Tubules, Proximal; Protein Serine-Threonine Kinases; Signal Transduction; Sodium
PubMed: 31262033
DOI: 10.3390/ijms20133219 -
Iranian Journal of Kidney Diseases Jul 2009Acute kidney failure (AKF) is a common clinical problem in neonatal intensive care units and is usually associated with a contributing condition such as sepsis,...
INTRODUCTION
Acute kidney failure (AKF) is a common clinical problem in neonatal intensive care units and is usually associated with a contributing condition such as sepsis, asphyxia, and heart failure. The aim of this study was to determine the types, frequency of associated contributing conditions, and short-term outcome of neonatal AKF.
MATERIALS AND METHODS
Medical records of neonates with a diagnosis of AKF from March 2003 to September 2006 were studied in a tertiary care children's hospital in Tabriz, Iran.
RESULTS
Of 6042 hospitalized neonates, 151 with documented AKF (100 boys and 51 girls) were reviewed in the study. Ninety-one patients (60.3%) had been referred from other cities. Fifty-seven patients (37.7%) developed AKF following a surgery. Causes of AKF were intrinsic kidney failure in 52.3%, prerenal in 42.4%, and postrenal in 5.3%. Oliguria was observed in 72.2% of the patients. Perinatal asphyxia was present in 29.8% of the neonates, sepsis in 28.5%, respiratory distress syndrome in 25.2%, dehydration in 24.2%, and heart failure in 21.2%. Most patients (85.4%) had more than 1 associated contributing condition. Mortality rate was 20.5%. Most patients (76.2%) were discharged with normal kidney function and 3.3% with diminished kidney function. Initial admission to NICU, female sex, septicemia, and the need for mechanical ventilation were associated with a higher mortality rate.
CONCLUSIONS
The frequency of associated contributing conditions and short-term outcome of neonatal AKF in our institution is comparable with other studies; however, intrinsic kidney failure comprises the most common form of AKF in our patients.
Topics: Acute Kidney Injury; Asphyxia Neonatorum; Dehydration; Female; Gestational Age; Heart Failure; Hospital Mortality; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Iran; Male; Respiratory Distress Syndrome, Newborn; Sepsis
PubMed: 19617661
DOI: No ID Found -
Hospital Practice (1995) Dec 2009Acute renal failure (ARF) is a common clinical syndrome characterized by an abrupt deterioration in kidney function, resulting in abnormalities in volume-regulatory,... (Review)
Review
Acute renal failure (ARF) is a common clinical syndrome characterized by an abrupt deterioration in kidney function, resulting in abnormalities in volume-regulatory, metabolic-regulatory, excretory, and endocrine functions. Despite decades of improvements in the provision of intensive care, and specifically in the provision of renal replacement therapy, the morbidity and mortality associated with acute kidney injury (AKI) remain extremely high. This article highlights novel cell therapies, advanced materials, and approaches to AKI with the aim of illuminating a potential path for future basic, translational, and clinical research using these novel modalities.
Topics: Acute Kidney Injury; Cell- and Tissue-Based Therapy; Critical Care; Evidence-Based Medicine; Humans; Kidney Function Tests; Nephrology; Renal Insufficiency
PubMed: 20877182
DOI: 10.3810/hp.2009.12.267 -
Clinical Journal of the American... Oct 2015AKI requiring RRT is associated with high mortality, morbidity, and long-term consequences, including CKD and ESRD. Many patients never recover kidney function; in... (Review)
Review
AKI requiring RRT is associated with high mortality, morbidity, and long-term consequences, including CKD and ESRD. Many patients never recover kidney function; in others, kidney function improves over a period of many weeks or months. Methodologic constraints of the available literature limit our understanding of the recovery process and hamper adequate intervention. Current management strategies have focused on acute care and short-term mortality, but new data indicate that long-term consequences of AKI requiring RRT are substantial. Promotion of kidney function recovery is a neglected focus of research and intervention. This lack of emphasis on recovery is illustrated by the relative paucity of research in this area and by the lack of demonstrated effective management strategies. In this article the epidemiologic implications of kidney recovery after AKI requiring RRT are discussed, the available literature and its methodologic constraints are reviewed, and strategies to improve the understanding of factors that affect kidney function recovery are proposed. Measures to promote kidney function recovery are a serious unmet need, with a great potential to improve short- and long-term patient outcomes.
Topics: Acute Kidney Injury; Anticoagulants; Humans; Kidney Failure, Chronic; Recovery of Function; Renal Replacement Therapy; Survival Rate; Time Factors; Water-Electrolyte Balance
PubMed: 26138260
DOI: 10.2215/CJN.01170215 -
Archivos Espanoles de Urologia Apr 2024This study aimed to analyse the risk factors and prognosis of sepsis complicated with acute kidney injury (AKI).
OBJECT
This study aimed to analyse the risk factors and prognosis of sepsis complicated with acute kidney injury (AKI).
METHODS
The clinical data of 324 patients with sepsis in the nephrology department of our hospital from January 2022 to January 2023 were collected. A total of 188 patients with AKI were the occurrence group, and 136 patients without AKI were the non-occurrence group. The influencing factors and prognosis of sepsis complicated with AKI were analysed.
RESULTS
We observed significant differences in Acute Physiology and Chronic Health Evaluation II (APACHE II), total length of hospital stay, Intensive Care Unit (ICU) stay, mechanical ventilation support, diabetes mellitus and urine volume >1500 mL between the two groups ( < 0.05). After a follow-up period of 1 month, 125 (66.49%) of 188 patients with sepsis complicated with AKI died, and 63 (33.51%) survived. The results of logistic regression analysis showed that Sequential Organ Failure Assessment (SOFA), APACHE II, mechanical ventilation support, diabetes, urine volume >1500 mL and serum creatinine were independent risk factors of sepsis complicated with AKI ( < 0.05). Moreover, SOFA, APACHE II, ICU admission days, mechanical ventilation support, serum creatinine and non-continuous renal replacement therapy were independent risk factors of death in patients with sepsis complicated with AKI ( < 0.05).
CONCLUSIONS
SOFA, APACHE II, ICU admission days, mechanical ventilation support, serum creatinine and non-continuous renal replacement therapy may be the influencing factors leading to death in patients with sepsis complicated with AKI. Early clinical intervention should be performed.
Topics: Humans; Acute Kidney Injury; Sepsis; Male; Female; Risk Factors; Prognosis; Middle Aged; Aged; Hospitalization; Retrospective Studies
PubMed: 38715167
DOI: 10.56434/j.arch.esp.urol.20247703.35 -
Nephron 2018While there are no clear definitions of recovery, it is clear that the goals of recovery depend on the severity of acute kidney injury and the clinical context. The... (Review)
Review
While there are no clear definitions of recovery, it is clear that the goals of recovery depend on the severity of acute kidney injury and the clinical context. The degree of renal recovery affects both renal and clinical prognosis. There are presently few guidelines on recovery targets, which range in extent from dialysis independence via normalization of serum creatinine to recovery of renal functional reserve. However, while there are no validated biomarkers for predicting recovery, evidence suggests that both functional and damage biomarkers can aid the assessment of recovery.
Topics: Acute Kidney Injury; Biomarkers; Humans; Kidney; Recovery of Function
PubMed: 30153675
DOI: 10.1159/000492290 -
Nephrology, Dialysis, Transplantation :... Jul 2012Klotho is highly expressed in the kidney and a soluble form of Klotho functions as an endocrine substance that exerts multiple actions including the modulation of renal... (Review)
Review
Klotho is highly expressed in the kidney and a soluble form of Klotho functions as an endocrine substance that exerts multiple actions including the modulation of renal solute transport and the protection of the kidney from a variety of insults in experimental models. At present, the Klotho database is still largely preclinical, but the anticipated forthcoming impact on clinical nephrology can be immense. This manuscript puts these potentials into perspective for the clinician. There is renal and systemic Klotho deficiency in both acute kidney injury (AKI) and chronic kidney disease (CKD). Klotho plummets very early and severely in AKI and represents a pathogenic factor that exacerbates acute kidney damage. In CKD, Klotho deficiency exerts a significant impact on progression of renal disease and extra renal complications. In AKI, soluble Klotho levels in plasma and/or urine may serve as an early biomarker for kidney parenchymal injury. Restoration by exogenous supplementation or stimulation of endogenous Klotho may prevent and/or ameliorate kidney injury and mitigate CKD development. In CKD, Klotho levels may be an indicator of early disease and predict the rate of progression, and presence and severity of soft tissue calcification. The correction of Klotho deficiency may delay progression and forestall development of extra renal complications in CKD. Rarely does one find a molecule with such broad potential applications in nephrology. Klotho can possibly emerge on the horizon as a candidate for an unprecedented sole biomarker and intervention. Nephrologists should monitor the progress of the preclinical studies and the imminently emerging human database.
Topics: Acute Kidney Injury; Animals; Biomarkers; Disease Progression; Glucuronidase; Humans; Kidney Failure, Chronic; Klotho Proteins
PubMed: 22802580
DOI: 10.1093/ndt/gfs160