Renal recovery after acute kidney injury

Acute kidney injury (AKI) is a frequent complication of critical illness and carries a significant risk of short- and long-term mortality, chronic kidney disease (CKD) and cardiovascular events. The degree of renal recovery from AKI may substantially affect these long-term endpoints. Therefore maxim...

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Veröffentlicht in:Intensive care medicine Jg. 43; H. 6; S. 855 - 866
Hauptverfasser: Forni, L. G., Darmon, M., Ostermann, M., Oudemans-van Straaten, H. M., Pettilä, V., Prowle, J. R., Schetz, M., Joannidis, M.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2017
Springer
Springer Nature B.V
Schlagworte:
Acute Kidney Injury - therapy
Age
Anesthesiology
Care and treatment
Chronic kidney failure
Creatinine
Creatinine - blood
Criteria
Critical Care Medicine
Critical Illness - therapy
Emergency Medicine
Epidemiology
Health aspects
Humans
Impairment
Injuries
Intensive
Intensive care
Kidney - physiopathology
Kidney diseases
Kidney Function Tests
Kidney transplantation
Kidneys
Medicine
Medicine & Public Health
Mortality
Pain Medicine
Patients
Pediatrics
Pneumology/Respiratory System
Proteinuria
Recovery
Recovery (Medical)
Recovery of Function
Renal function
Renal Insufficiency, Chronic - therapy
Repair
Review
Risk analysis
Risk factors
Stresses
United Kingdom
Biomarkers
Chronic kidney disease
Renal replacement therapy
Acute kidney injury
Acute kidney disease
Follow-up
ISSN:0342-4642, 1432-1238, 1432-1238
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Zusammenfassung:Acute kidney injury (AKI) is a frequent complication of critical illness and carries a significant risk of short- and long-term mortality, chronic kidney disease (CKD) and cardiovascular events. The degree of renal recovery from AKI may substantially affect these long-term endpoints. Therefore maximising recovery of renal function should be the goal of any AKI prevention and treatment strategy. Defining renal recovery is far from straightforward due in part to the limitations of the tests available to assess renal function. Here, we discuss common pitfalls in the evaluation of renal recovery and provide suggestions for improved assessment in the future. We review the epidemiology of renal recovery and of the association between AKI and the development of CKD. Finally, we stress the importance of post-discharge follow-up of AKI patients and make suggestions for its incorporation into clinical practice. Summary key points are that risk factors for non-recovery of AKI are age, CKD, comorbidity, higher severity of AKI and acute disease scores. Second, AKI and CKD are mutually related and seem to have a common denominator. Third, despite its limitations full recovery of AKI may best be defined as the absence of AKI criteria, and partial recovery as a fall in AKI stage. Fourth, after an episode of AKI, serial follow-up measurements of serum creatinine and proteinuria are warranted to diagnose renal impairment and prevent further progression. Measures to promote recovery are similar to those preventing renal harm. Specific interventions promoting repair are still experimental.
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ISSN:0342-4642
1432-1238
1432-1238
DOI:10.1007/s00134-017-4809-x