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Renal recovery after acute kidney injury

Forni, L.G., Darmon, M., Ostermann, M., Oudemans-van Straaten, H.M., Pettilä, V., Prowle, J.R., Schetz, M. and Joannidis, M. (2017) Renal recovery after acute kidney injury Intensive Care Medicine, 43 (6). pp. 855-866.

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Abstract

Acute kidney injury (AKI) is a frequent complication of critical illness and carries a significant risk of short- and longterm 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.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
NameEmailORCID
Forni, L.G.l.forni@surrey.ac.uk
Darmon, M.
Ostermann, M.
Oudemans-van Straaten, H.M.
Pettilä, V.
Prowle, J.R.
Schetz, M.
Joannidis, M.
Date : June 2017
DOI : 10.1007/s00134-017-4809-x
Copyright Disclaimer : © The Author(s) 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Uncontrolled Keywords : Acute kidney injury; Acute kidney disease; Chronic kidney disease; Renal replacement therapy,; Follow-up; Biomarkers
Additional Information : Open access funding provided by University of Innsbruck and Medical University of Innsbruck.
Depositing User : Diane Maxfield
Date Deposited : 24 Oct 2019 11:26
Last Modified : 24 Oct 2019 11:26
URI: http://epubs.surrey.ac.uk/id/eprint/852729

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