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Three feasible strategies to minimize kidney injury in 'incipient AKI'

Nature Reviews Nephrology volume 9, pages 484–490 (2013)Cite this article

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Abstract

Acute kidney injury (AKI) is common and increasing in hospitalized patients. The earlier recognition of renal injury, at a stage described as 'incipient AKI', may allow renoprotective strategies to be initiated at a time when more kidney tissue is salvageable. 'Incipient AKI' represents renal injury as manifested by new-onset proteinuria, cellular activity on urine microscopy, or elevated novel biomarkers of kidney injury in the absence of clinical data that meet current diagnostic criteria for AKI. We propose three strategies to preserve kidney function and minimize further kidney injury in patients with 'incipient AKI'. These include—when appropriate for the prevailing cause of 'incipient AKI'—use of low-chloride-containing intravenous solutions, continued use of renin–angiotensin system antagonists, and use of diuretics to achieve adequate control of intravascular volume. The combined approach of the early diagnosis of AKI and early employment of feasible therapeutic strategies may slow the growth of clinical AKI, AKI requiring renal replacement therapy and chronic kidney disease, and might reduce AKI-associated mortality.

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Figure 1: Continuum of tubular injury.
Figure 2: Spectrum of renal injury in acute kidney disease.
Figure 3: Effect of RAS blockade on peritubular blood flow.

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Acknowledgements

S. G. Coca is supported by National Institutes of Health Grants K23DK080132 and R01DK096549. S. G. Coca is also a member of the NIH-sponsored ASsess, Serial Evaluation, and Subsequent Sequelae in Acute Kidney Injury (ASSESS-AKI) Consortium (U01DK082185).

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  1. Yale University School of Medicine, Section of Nephrology, 330 Cedar Street, New Haven, 06520, CT, USA

    Mark A. Perazella & Steven G. Coca

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The authors contributed equally to all aspects of this manuscript.

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Correspondence to Steven G. Coca.

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Perazella, M., Coca, S. Three feasible strategies to minimize kidney injury in 'incipient AKI'. Nat Rev Nephrol 9, 484–490 (2013). https://doi.org/10.1038/nrneph.2013.80

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