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Renal Recovery

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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
Aaron J Polichnowski
Acute kidney injury (AKI) is a major complication in hospitalized patients and is associated with elevated mortality rates. Numerous recent studies indicate that AKI also significantly increases the risk of chronic kidney disease (CKD), end-stage renal disease (ESRD), hypertension, cardiovascular disease and mortality in those patients that survive AKI. Moreover, the risk of ESRD and mortality after AKI is substantially higher in patients with preexisting CKD. However, the underlying mechanisms by which AKI and CKD interact to promote ESRD remain poorly understood...
September 26, 2018: American Journal of Physiology. Renal Physiology
Shuang Cui, Liling Wu, Xiaodan Feng, Huanjuan Su, Zhanmei Zhou, Weihong Luo, Cailing Su, Yajing Li, Meng Shi, Zhichen Yang, Wei Cao
One of the major obstacles to prevent AKI-CKD transition is the lack of effective methods to follow and predict the ongoing kidney injury after an AKI episode. In the present study, we test the utility of urinary angiotensinogen (UAGT) for dynamically evaluating renal structural changes and predicting AKI-CKD progression by using both mild and severe bilateral renal ischemia/reperfusion injury mice. UAGT returns to pre-ischemic levels 14 days after mild AKI followed by kidney architecture restoration, whereas sustained increase in UAGT accompanies by ongoing renal fibrosis after severe AKI...
October 15, 2018: Clinical Science (1979-)
Zoltán H Endre
While there are no clear definitions of recovery, it is clear that the goals of recovery depend on the severity of acute kidney injury and the clinical context. The degree of renal recovery affects both renal and clinical prognosis. There are presently few guidelines on recovery targets, which range in extent from dialysis independence via normalization of serum creatinine to recovery of renal functional reserve. However, while there are no validated biomarkers for predicting recovery, evidence suggests that both functional and damage biomarkers can aid the assessment of recovery...
2018: Nephron
Esther Peters, Massimo Antonelli, Xavier Wittebole, Rahul Nanchal, Bruno François, Yasser Sakr, Jean-Louis Vincent, Peter Pickkers
BACKGROUND: Acute kidney injury (AKI) is a common complication of critical illness and is associated with worse outcomes. However, the influence of deterioration or improvement in renal function on clinical outcomes is unclear. Using a large international database, we evaluated the prevalence and evolution of AKI over a 7-day period and its effects on clinical outcomes in septic and non-septic critically ill patients worldwide. METHODS: From the 10,069 adult intensive care unit (ICU) patients in the Intensive Care Over Nations database, all those with creatinine and urine output data were included in this substudy...
August 3, 2018: Critical Care: the Official Journal of the Critical Care Forum
Jianchun Chen, Huaizhou You, Yan Li, You Xu, Qian He, Raymond C Harris
BACKGROUND: Increasing evidence indicates that renal recovery from AKI stems from dedifferentiation and proliferation of surviving tubule epithelial cells. Both EGF receptor (EGFR) and the Hippo signaling pathway are implicated in cell proliferation and differentiation, and previous studies showed that activation of EGFR in renal proximal tubule epithelial cells (RPTCs) plays a critical role in recovery from ischemia-reperfusion injury (IRI). In this study, we explored RPTC activation of Yes-associated protein (YAP) and transcriptional coactivator with PDZ binding motif (TAZ), two key downstream effectors of the Hippo pathway, and their potential involvement in recovery from AKI...
September 2018: Journal of the American Society of Nephrology: JASN
Helmut Schiffl
INTRODUCTION: Severe acute kidney injury (AKI-D) is common in critically ill patients and contributes substantially to short- and long-term morbidity and mortality. Acute renal replacement therapy (RRT) is an increasingly widely utilized life-sustaining support strategy for AKI-D patients, providing a bridge to renal recovery in many survivors of AKI. However, key aspects (when and how) of this therapy's appropriate cessation remain unclear. Today, wide variation in clinical practice exists regarding the indication for and the timing of RTT discontinuation, likely due to the poor current evidence base...
October 2018: International Urology and Nephrology
Faeq Husain-Syed, Fiorenza Ferrari, Aashish Sharma, Tommaso Hinna Danesi, Pércia Bezerra, Salvador Lopez-Giacoman, Sara Samoni, Massimo de Cal, Valentina Corradi, Grazia Maria Virzì, Silvia De Rosa, María Jimena Muciño Bermejo, Carla Estremadoyro, Gianluca Villa, Jose J Zaragoza, Carlotta Caprara, Alessandra Brocca, Horst-Walter Birk, Hans-Dieter Walmrath, Werner Seeger, Federico Nalesso, Monica Zanella, Alessandra Brendolan, Davide Giavarina, Loris Salvador, Rinaldo Bellomo, Mitchell H Rosner, John A Kellum, Claudio Ronco
Background: Cardiac surgery is a leading cause of acute kidney injury (AKI). Such AKI patients may develop progressive chronic kidney disease (CKD). Others, who appear to have sustained no permanent loss of function (normal serum creatinine), may still lose renal functional reserve (RFR). Methods: We extended the follow-up in the observational 'Preoperative RFR Predicts Risk of AKI after Cardiac Surgery' study from hospital discharge to 3 months after surgery for 86 (78...
July 19, 2018: Nephrology, Dialysis, Transplantation
Giuseppe Orlando, Richard Danger, Hayrettin Okut, Lauren Edgar, Benedetta Bussolati, Emily Gall, Christopher R Bergman, Riccardo Tamburrini, Carlo Gazia, Alan C Farney, Barry I Freedman, Gwen McPherson, Jeffrey Rogers, Robert J Stratta, Sophie Brouard, Stephen J Walker
OBJECTIVE: To test the hypothesis that gene expression profiling in peripheral blood from patients who have undergone kidney transplantation (KT) will provide mechanistic insights regarding graft repair and regeneration. BACKGROUND: Renal grafts obtained from living donors (LD) typically function immediately, whereas organs from donation after cardiac death (DCD) or acute kidney injury (AKI) donors may experience delayed function with eventual recovery. Thus, recipients of LD, DCD, and AKI kidneys were studied to provide a more complete understanding of the molecular basis for renal recovery...
July 24, 2018: Annals of Surgery
Maija Eskola, Suvi T Vaara, Anna-Maija Korhonen, Jukka Sauranen, Niina Koivuviita, Eero Honkanen, Ville Pettilä, Mikko Haapio
BACKGROUND: Studies reporting renal and overall survival after acute kidney injury (AKI) treated exclusively with intermittent modalities of renal replacement therapy (IRRT) are rare. This study focused on outcomes of AKI patients treated with IRRT both in intensive care units (ICUs) and non-ICU dialysis units. METHODS: This prospective observational study was carried on during a 5-month period in 17 ICUs and 17 non-ICUs. ICU and non-ICU patients (total n = 138; 65 ICU, 73 non-ICU) requiring RRT for AKI and chosen to receive IRRT were included...
November 2018: Acta Anaesthesiologica Scandinavica
Harin Rhee, Gum Sook Jang, Yeo Jin An, Miyeun Han, Inseong Park, Il Young Kim, Eun Young Seong, Dong Won Lee, Soo Bong Lee, Ihm Soo Kwak, Sang Heon Song
INTRODUCTION: Acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) is the most severe form of AKI associated with poor short- and long-term patient outcomes. The aim of this study was to evaluate the variables associated with long-term patient survival in our clinic. METHODS: This was a single-center retrospective study with AKI survivors who received CRRT from March 2011 to February 2015. During the study period, all consecutive AKI survivors who underwent CRRT were included...
December 2018: Clinical and Experimental Nephrology
Richard J Fluck
PURPOSE OF REVIEW: Acute kidney injury (AKI) is common, harmful and of global concern. There is a need to understand the pathway of the management of AKI in order to identify potential areas where care can be improved, for the individual and for healthcare systems. RECENT FINDINGS: There has been considerable focus on risk assessment and earlier detection using changes in serum creatinine. There is less understanding of optimal management, enhanced and long-term recovery, and education to support better care...
November 2015: Current Opinion in Nephrology and Hypertension
Antoine Dewitte, Olivier Joannès-Boyau, Carole Sidobre, Catherine Fleureau, Marie-Lise Bats, Philippe Derache, Sébastien Leuillet, Jean Ripoche, Christian Combe, Alexandre Ouattara
BACKGROUND AND OBJECTIVES: Prompt recognition of severe renal impairment could improve the early management of critically ill patients. We compared the value of kinetic eGFR, plasma neutrophil gelatinase-associated lipocalin (NGAL), and urine tissue inhibitor of metalloproteinase-2 and urine insulin-like growth factor-binding protein 7 ([TIMP-2]*[IGFBP7]) in predicting short-term recovery from AKI and major adverse kidney events. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: During the 6-month study period, 245 patients were admitted to our intensive care unit...
November 6, 2015: Clinical Journal of the American Society of Nephrology: CJASN
Julius J Schmidt, Gernot Beutel, Jan T Kielstein
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...
February 2015: Deutsche Medizinische Wochenschrift
Sanjeev Kumar, Jing Liu, Andrew P McMahon
The mammalian kidney has an intrinsic ability to repair after significant injury. However, this process is inefficient: patients are at high risk for the loss of kidney function in later life. No therapy exists to treat established acute kidney injury (AKI) per se: strategies to promote endogenous repair processes and retard associated fibrosis are a high priority. Whole-organ gene expression profiling has been used to identify repair responses initiated with AKI, and factors that may promote the transition from AKI to chronic kidney disease...
July 2014: Seminars in Nephrology
Benjamin J Lee, Chi-Yuan Hsu, Rishi V Parikh, Thomas K Leong, Thida C Tan, Sophia Walia, Kathleen D Liu, Raymond K Hsu, Alan S Go
BACKGROUND: The high mortality and cardiovascular disease (CVD) burden in patients with end-stage renal disease (ESRD) is well-documented. Recent literature suggests that acute kidney injury is also associated with CVD. It is unknown whether patients with incident ESRD due to dialysis-requiring acute kidney injury (AKI-D) are at higher short-term risk for death and CVD events, compared with incident ESRD patients without preceding AKI-D. Few studies have examined the impact of recovery from AKI-D on subsequent CVD risk...
June 11, 2018: BMC Nephrology
John A Kellum, Rinaldo Bellomo, Claudio Ronco
No abstract text is available yet for this article.
August 7, 2018: JAMA: the Journal of the American Medical Association
Marco Fiorentino, Fadi A Tohme, Shu Wang, Raghavan Murugan, Derek C Angus, John A Kellum
BACKGROUND: Several studies have shown that long-term survival after acute kidney injury (AKI) is reduced even if there is clinical recovery. However, we recently reported that in septic shock patients those that recover from AKI have survival similar to patients without AKI. Here, we studied a cohort with less severe sepsis to examine the effects of AKI on longer-term survival as a function of recovery by discharge. METHODS: We analyzed patients with community-acquired pneumonia from the Genetic and Inflammatory Markers of Sepsis (GenIMS) cohort...
2018: PloS One
Po-Hung Lee, Vin-Cent Wu, Fu-Chang Hu, Chun-Fu Lai, Yung-Ming Chen, Tun-Jun Tsai, Kwan-Dun Wu
BACKGROUND: Information is limited regarding the outcomes of patients with preexisting chronic kidney disease (CKD) who develop dialysis-requiring acute kidney injury. METHODS: 131 adult patients with advanced CKD who received emergent hemodialysis from January to June in 2002 were recruited and monitored for all-cause mortality and end-stage renal disease until the end of 2007. RESULTS: Among patients investigated, 21 (16%) were successfully withdrawn from acute hemodialysis after an average of 8 sessions of dialysis therapy (range: 1-44)...
2011: American Journal of Nephrology
Hadi Fattah, Volker Vallon
BACKGROUND: A significant portion of patients who are affected by acute kidney injury (AKI) do not fully recover due to largely unclear reasons. Restoration of tubular function has been proposed to be a prerequisite for glomerular filtration rate (GFR) recovery. SUMMARY: Proximal tubular cells dedifferentiate during the tubular injury phase, which is required for subsequent cell proliferation and replacement of lost epithelial cells. Experimental studies indicate that some cells fail to redifferentiate and continue to produce growth factors (e...
2018: Nephron
Gautam Ram Choudhary, Arup Kumar Mandal, Uttam Mete, Ravimohan Mavuduru, Anish Bhatacharia, Anupam Lal, Suresh Goyal
Purpose: Preservation of renal function after nephron-sparing surgery (NSS) is multifactorial and the impact of individual factors on it is still a debate. This prospective study investigates the impact of factors responsible for quantitative and functional outcome after NSS. Patients and Methods: Fifty-two patients of localized renal mass (≤7 cm) were included in the study. A contrast-enhanced computed tomography abdomen was performed for characterization of tumor...
2018: Journal of Clinical Imaging Science
2018-05-20 11:05:24
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