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Conceptual advances and evolving terminology in acute kidney disease

Nature Reviews Nephrology volume 17, pages 493–502 (2021)Cite this article

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Abstract

Over the past decade, new insights into epidemiology, pathophysiology and biomarkers have modified our understanding of acute kidney dysfunction and damage, and their association with subsequent chronic kidney disease. The concept of acute kidney injury (AKI), which has relied on established but nonetheless flawed biomarkers of solute clearance (serum creatinine levels and urinary output), has been challenged by the identification of novel biomarkers of tubular stress and/or damage. The expression of some of these novel biomarkers precedes changes in conventional biomarkers or can increase their predictive power, and might therefore enhance the clinical accuracy of the definition of AKI. In addition, the need to consider AKI recurrence, duration and progression to chronic kidney disease within the clinical and epidemiological framework of AKI led to the emergence of the concept of acute kidney disease. New definitions of acute syndromes of kidney impairment and injury are needed.

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Fig. 1: Changes in kidney structure and function.
Fig. 2: Resting and stress glomerular function and its relationship to serum creatinine.
Fig. 3: Types and consequences of kidney damage and dysfunction.
Fig. 4: Markers and characteristics of kidney disease.
Fig. 5: Pathogenesis and clinical consequences of various forms of AKI.

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Authors and Affiliations

  1. Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    John A. Kellum

  2. Department of Medicine, University of Padova, Padova, Italy

    Claudio Ronco

  3. International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy

    Claudio Ronco

  4. Department of Nephrology, San Bortolo Hospital, Vicenza, Italy

    Claudio Ronco

  5. Department of Critical Care, Austin Hospital, Melbourne, Australia

    Rinaldo Bellomo

  6. Department of Critical Care, The University of Melbourne, Melbourne, Australia

    Rinaldo Bellomo

  7. Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia

    Rinaldo Bellomo

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All authors researched data for the article, made substantial contributions to discussions of the content, wrote the manuscript, and reviewed or edited the manuscript before submission.

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Correspondence to John A. Kellum.

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J.A.K. discloses consulting fees and grant support from Baxter, bioMerieux/Astute Medical and Bioporto. R.B. discloses grant support from Ortho Diagnostics and speaking fees from bioMérieux. C.R. discloses consulting fees from Baxter, and speaking fees from Ortho Diagnostics, bioMérieux and Bioporto.

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Kellum, J.A., Ronco, C. & Bellomo, R. Conceptual advances and evolving terminology in acute kidney disease. Nat Rev Nephrol 17, 493–502 (2021). https://doi.org/10.1038/s41581-021-00410-w

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