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Acute kidney injury

Acute kidney injury: still misunderstood and misdiagnosed

New research supports the notion that pre-renal and intrinsic acute kidney injury are distinct molecular entities and hence different disease states despite similar increases in serum creatinine level. Pre-renal AKI induces protective molecular mechanisms whereas intrinsic AKI requires a 'second hit' that upregulates injury genes, and results in a persistent elevation of serum creatinine and kidney injury biomarkers.

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References

  1. KDIGO. KDIGO clinical practice guideline for acute kidney injury. Kidney Int. Suppl. 2, 1–138 (2012).

  2. Uchino, S., Bellomo, R., Bagshaw, S. M. & Goldsmith, D. Transient azotemia is associated with a high risk of death in hospitalized patients. Nephrol. Dial. Transplant. 25, 1833–1839 (2010).

    Article  Google Scholar 

  3. Nickolas, T. L. et al. Diagnostic and prognostic stratification in the emergency department using urinary biomarkers of nephron damage: a multicenter prospective cohort study. J. Am. Coll. Cardiol. 59, 246–255 (2012).

    Article  CAS  Google Scholar 

  4. Soto, K. et al. The risk of chronic kidney disease and mortality are increased after community-acquired acute kidney injury. Kidney Int. 90, 1090–1099 (2016).

    Article  Google Scholar 

  5. Xu, K. et al. Unique transcriptional programs identify subtypes of AKI. J. Am. Soc. Nephrol. http://dx.doi.org/10.1681/ASN.2016090974 (2016).

  6. Supavekin, S. et al. Differential gene expression following early ischemia/reperfusion. Kidney Int. 63, 1714–1724 (2003).

    Article  CAS  Google Scholar 

  7. Devarajan, P. Genomic and proteomic characterization of acute kidney injury. Nephron 131, 85–91 (2015).

    Article  CAS  Google Scholar 

  8. Haase-Fielitz, A., Haase, M. & Devarajan, P. Neutrophil gelatinase-associated lipocalin as a biomarker of acute kidney injury: a critical evaluation of current status. Ann. Clin. Biochem. 51, 335–351 (2014).

    Article  CAS  Google Scholar 

  9. Murray, P. T. et al. ADQI10 workshop. Potential use of biomarkers in acute kidney injury: report and summary of recommendations from the 10th Acute Dialysis Quality Initiative consensus conference. Kidney Int. 85, 513–521 (2014).

    Article  Google Scholar 

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Acknowledgements

P.D. has received funding from the NIH (grant number P50DK096418).

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Correspondence to Prasad Devarajan.

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P.D. is a co-inventor on patents (7776824 and 7977110) related to NGAL as a biomarker of kidney injury, and declares licensing agreements with BioPorto Diagnostics and Abbott Diagnostics.

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Devarajan, P. Acute kidney injury: still misunderstood and misdiagnosed. Nat Rev Nephrol 13, 137–138 (2017). https://doi.org/10.1038/nrneph.2017.9

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