[Diagnosis and pathophysiology of acute renal failure - is prevention possible?].

Acute kidney injury (AKI) in critically ill patients is on a dramatic rise. The same holds true for community acquired AKI. Two main mechanisms are responsible for this increase: the rising prevalence of chronic kidney disease and the progress in diagnostic and therapeutic procedures pushing the limits of impossible. Several new biomarkers have not only helped to identify patients at risk for AKI and diagnosing AKI within hours after the insult, they also helped improve our pathophysiological understanding of AKI. The increase in AKI and new diagnostic markers of it is currently not matched by an increase in prophylactic or therapeutic interventions. It is quite the opposite. For decades we have seen spectacular effects of new drugs and interventions in the preclinical setting, always followed by a miserable failure at the bedside. It seems that one non-pharmacological intervention, i. e. the human resource of being educated in nephrology might be of importance not only for those suffering from AKI in the intensive care unit but also for those surviving it. This comes to no surprise if one considers acute and chronic kidney diseases not as separate entities but rather as closely interconnected.