Volume 7 Issue 4, April 2011

A recent observational study from the UK raises questions over the control of mineral metabolism parameters to within target levels defined by the KDOQI clinical practice guidelines. Data from this study highlight the need for a randomized controlled trial to determine whether optimal management of bone mineral metabolism actually provides any survival benefit.

Individuals with HIV disease frequently experience kidney dysfunction, which is accompanied by an increased risk of cardiovascular disease and death. Choi et al. have found that albuminuria and an estimated glomerular filtration rate of <60 ml/min/1.73 m², estimated using serum cystatin C level, accounted for 17% of the population-attributable 5-year mortality risk in a cohort of patients with HIV infection.

Ischemia is the most common cause of acute kidney injury (AKI) in hospitalized patients. The authors of this Review describe the morphological and functional responses of kidney cells to ischemic injury. They also outline the characteristics of patients who are at highest risk of developing ischemic AKI and discuss therapeutic strategies for the prevention and management of this condition.

Acute kidney injury (AKI) is often overlooked in hospitalized patients, despite a strong association with poor clinical outcomes. In this Review, Ricci et al. discuss the advantages and limitations of the RIFLE and AKIN consensus definitions for AKI. The authors also consider the integration of novel biomarkers into these definitions to aid early diagnosis and prediction of the prognosis of AKI.

Acute kidney injury (AKI) is common, especially in the critically ill, and is a serious condition associated with substantial morbidity and mortality. In this Review, Murugan and Kellum discuss the epidemiology and prognosis of critically ill patients with AKI as well as describe the role of AKI criteria, biomarkers and therapy on patient outcomes.

Sepsis is the most common and severe cause of morbidity and mortality among critically ill patients. Acute kidney injury (AKI) can complicate sepsis, with a linear relationship between the severity of kidney damage and patient prognosis. In this Review, the authors describe currently available interventions for sepsis-related AKI. In addition, they discuss preventive methods, pharmacological support and extracorporeal blood purification for septic AKI.

Fluctuating renal and volume status means that drug dosing in critically ill patients with acute kidney injury is complex. In this Review, Eyler and Mueller highlight the substantial variability in pharmacodynamics and pharmacokinetics that exists in this population, and discuss how antibiotic-dosing decisions should not just be based on published guidelines—clinicians must also take into account patient characteristics, choice of renal replacement therapy, and drug-related factors.

Cinacalcet, a calcimimetic drug, is an attractive treatment for renal transplant patients who experience persistent hyperparathyroidism and hypercalcemia. In this article, however, Seikrit et al. present the case of a 47-year-old man who experienced fulminant renal allograft failure after receiving cinacalcet soon after transplantation. The authors also discuss the possible pathophysiological connection between cinacalcet administration and failure of the transplanted kidney.

Acute kidney injury (AKI) is a serious complication that commonly occurs in critically ill patients and is associated with considerable morbidity and mortality. Despite advances in our understanding of the pathogenesis of AKI, the ability to stratify risk and assess disease prognosis remains limited. This Focus Issue on AKI in Critical Care contains five specially commissioned Review articles that describe our current understanding of the pathophysiology, classification, prognosis, and management of critically ill patients with AKI.