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2017 ; 43
(6
): 855-866
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Renal recovery after acute kidney injury
#MMPMID28466146
Forni LG
; Darmon M
; Ostermann M
; Oudemans-van Straaten HM
; Pettilä V
; Prowle JR
; Schetz M
; Joannidis M
Intensive Care Med
2017[Jun]; 43
(6
): 855-866
PMID28466146
show ga
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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