![]() ![]() Given that the kidney provides life-sustaining functions, severe AKI can be lethal hence, appropriate management including kidney replacement therapy (KRT), if needed, is essential. Importantly, both functional impairment (serum creatinine level elevation and/or urine output decline) and presence of biomarkers indicating structural damage are associated with marked increases in mortality in the appropriate clinical context, for example, in cases of critical illness in which they increase hospital mortality 3–7-fold 6, 7, 8, 9, whereas the same changes may not have long-term health implications in other settings, such as in marathon runners 10. A consensus statement published in 2020 suggested that damage biomarkers should be integrated into the definition of AKI to augment its classification (Table 2) 5. Unfortunately, direct assessment of kidney damage, apart from biopsy, is not possible with existing technology hence, numerous urinary biomarkers are in use or have been proposed as indicators of glomerular or tubular cell injury 4. However, AKI persisting despite volume therapy probably indicates structural damage to the kidney 3. Similarly, renin–angiotensin system inhibitors or other drugs that affect glomerular filtration may result in small changes in serum creatinine levels that are not indicative of kidney injury 2. A few hours of volume depletion in an otherwise healthy human may have no long-term health implications. In the absence of injury markers, individuals with episodes of transient volume depletion can meet the diagnostic criteria of AKI without injury being present. Thus, prevention and early detection of AKI are essential.Īs the diagnostic markers serum creatinine and urine output level measure loss of kidney function and not injury, AKI can be seen as a misnomer. Long-term consequences of AKI and AKD include CKD and cardiovascular morbidity. AKI has a poor prognosis in critically ill patients. As AKI can be lethal, kidney replacement therapy is frequently required. ![]() Fluid and electrolyte management are essential. ![]() AKI management in critical care settings is challenging, including appropriate volume control, nephrotoxic drug management, and the timing and type of kidney support. The large spectrum of AKI implies diverse pathophysiological mechanisms. Infection and trauma-related AKI and AKD are frequent in all regions. In high-income countries, AKI mostly occurs in elderly patients who are in hospital, and is related to sepsis, drugs or invasive procedures. In low-income and middle-income countries, infections and hypovolaemic shock are the predominant causes of AKI. New biomarkers to identify injury before function loss await clinical implementation. AKI is part of a range of conditions summarized as acute kidney diseases and disorders (AKD), in which slow deterioration of kidney function or persistent kidney dysfunction is associated with an irreversible loss of kidney cells and nephrons, which can lead to chronic kidney disease (CKD). Acute kidney injury (AKI) is defined by a sudden loss of excretory kidney function. ![]()
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