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AKI CKD Transition

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78 papers 25 to 100 followers
By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
Horng-Ruey Chua, Weng-Kin Wong, Venetia Huiling Ong, Dipika Agrawal, Anantharaman Vathsala, Hui-Ming Tay, Amartya Mukhopadhyay
PURPOSE: To evaluate 1-year mortality in patients with septic acute kidney injury (AKI) and to determine association between initial AKI recovery patterns ( reversal within 5 days, beyond 5 days but recovery, or nonrecovery) and chronic kidney disease (CKD) progression. METHODS: Prospective observational study, with retrospective evaluation of initial nonconsenters, of critically ill patients with septic AKI. RESULTS: We studied 207 patients (age, mean [SD]: 64 [16] years, 39% males), of which 56 (27%), 18 (9%), and 9 (4%) died in intensive care unit (ICU), post-ICU in hospital, and posthospitalization, respectively...
January 1, 2018: Journal of Intensive Care Medicine
Brendan Bowman, Sijie Zheng, Alex Yang, Brigitte Schiller, José A Morfín, Melvin Seek, Robert S Lockridge
Dialysis care in the United States continues to move toward an emphasis on continuous quality improvement and performance benchmarking. Government- and industry-sponsored programs have evolved to assess and incentivize outcomes for many components of end-stage renal disease care. One aspect that remains largely unaddressed at a systemic level is the high-risk transition period from chronic kidney disease and acute kidney injury to permanent dialysis dependence. Incident dialysis patients experience disproportionately high mortality and hospitalization rates coupled with high costs...
March 3, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Peter K Moore, Raymond K Hsu, Kathleen D Liu
Acute kidney injury (AKI) is a heterogeneous disorder that is common in hospitalized patients and associated with short- and long-term morbidity and mortality. When AKI is present, prompt workup of the underlying cause should be pursued, with specific attention to reversible causes. Measures to prevent AKI include optimization of volume status and avoidance of nephrotoxic medications. Crystalloids are preferred over colloids for most patients, and hydroxyethyl starches should be avoided. Volume overload in the setting of AKI is associated with adverse outcomes, so attention should be paid to overall fluid balance...
February 22, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Marco Fiorentino, Giuseppe Grandaliano, Loreto Gesualdo, Giuseppe Castellano
BACKGROUND: Acute kidney injury (AKI), even if followed by renal recovery, is a risk factor for the future development of chronic kidney disease (CKD) and end-stage renal disease (ESRD). In the previous years, novel insights in the pathophysiology of CKD progression suggested a causal link between AKI and CKD due to a maladaptive repair after severe and repeated injury. SUMMARY: Several pathological mechanisms have been proposed to contribute to the progression of AKI and transition to CKD/ESRD including hypoxia and microvascular rarefaction, alterations of renal resident cell phenotypes and functions, cell cycle arrest in the G2/M phase, persistent chronic inflammation, and development of interstitial fibrosis, mitochondrial fragmentation, epigenetic changes, activation of renin-angiotensin system (RAS), cell and tissue senescence...
2018: Contributions to Nephrology
Vaka K Sigurjonsdottir, Swasti Chaturvedi, Cherry Mammen, Scott M Sutherland
Acute kidney injury (AKI) is characterized clinically as an abrupt decline in renal function marked by reduced excretion of waste products, disordered electrolytes, and disrupted fluid homeostasis. The recent development of a standardized AKI definition has transformed our understanding of AKI epidemiology and outcomes. We now know that in the short term, children with AKI experience greater morbidity and mortality; additionally, observational studies have established that chronic renal sequelae are far more common after AKI events than previously realized...
January 26, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Bi-Cheng Liu, Tao-Tao Tang, Lin-Li Lv, Hui-Yao Lan
Renal tubules are the major component of the kidney and are vulnerable to a variety of injuries including hypoxia, proteinuria, toxins, metabolic disorders, and senescence. It has long been believed that tubules are the victim of injury. In this review, we shift this concept to renal tubules as a driving force in the progression of kidney diseases. In response to injury, tubular epithelial cells undergo changes and function as inflammatory and fibrogenic cells, with the consequent production of various bioactive molecules that drive interstitial inflammation and fibrosis...
March 2018: Kidney International
David M Small, Washington Y Sanchez, Sandrine F Roy, Christudas Morais, Heddwen L Brooks, Jeff S Coombes, David W Johnson, Glenda C Gobe
Oxidative stress and mitochondrial dysfunction exacerbate acute kidney injury (AKI) but their role in any associated progress to chronic kidney disease (CKD) remains unclear. Antioxidant therapies often benefit AKI but their benefits in CKD are controversial since clinical and pre-clinical investigations often conflict. Here we examined the influence of the antioxidant, N-acetyl cysteine (NAC) on oxidative stress and mitochondrial function during AKI (20-minute bilateral renal ischemia plus reperfusion/IR) and progression to chronic kidney pathologies in mice...
January 10, 2018: American Journal of Physiology. Renal Physiology
Michael Hultström, Mediha Becirovic-Agic, Sofia Jönsson
Acute kidney injury (AKI) is a syndrome of reduced glomerular filtration rate and urine production caused by a number of different diseases. It is associated with renal tissue damage. This tissue damage can cause tubular atrophy and interstitial fibrosis that leads to nephron loss and progression of chronic kidney disease (CKD). This review describes the in-common mechanisms behind tissue damage in AKI caused by different underlying diseases. Comparing six high-quality microarray studies of renal gene expression after AKI in disease models (gram-negative sepsis, gram-positive sepsis, ischemia-reperfusion, malignant hypertension, rhabdomyolysis, and cisplatin toxicity) identified 5,254 differentially expressed genes in at least one of the AKI models; 66% of genes were found only in one model, showing that there are unique features to AKI depending on the underlying disease...
March 1, 2018: Physiological Genomics
Søren Christiansen, Steffen Christensen, Lars Pedersen, Henrik Gammelager, J Bradley Layton, M Alan Brookhart, Christian Fynbo Christiansen
BACKGROUND: The optimal time to initiate renal replacement therapy (RRT) in intensive care unit (ICU) patients with acute kidney injury (AKI) is unclear. We examined the impact of early RRT on long-term mortality, risk of chronic kidney disease (CKD), and end-stage renal disease (ESRD). METHODS: This cohort study included all adult patients treated with continuous RRT in the ICU at Aarhus University Hospital, Skejby, Denmark (2005-2015). Data were obtained from a clinical information system and population-based registries...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
Tetsuhiro Tanaka
Underlying mechanisms accounting for the transition of AKI to CKD have been eagerly sought. Candidates so far include nephron loss, inflammation, endothelial injury with vascular rarefaction and cell cycle arrest in epithelial cells. Among them, hypoxia is increasingly recognized as a common pathway mediating transition from AKI to CKD 2 . This article is protected by copyright. All rights reserved.
December 28, 2017: Acta Physiologica
Samir S Patel, Carlos E Palant, Vrinda Mahajan, Lakhmir S Chawla
Large epidemiologic studies in a variety of patient populations reveal increased morbidity and mortality that occur months to years after an episode of acute kidney injury (AKI). Even milder forms of AKI have increased associated morbidity and mortality. Residual confounding may account for these findings, but considering the huge number of individuals afflicted with AKI, the sequelae of AKI may be a very large public health burden. AKI may simply be a marker for increased risk, but there is increasing evidence that it is part of the causal pathway to chronic kidney disease...
September 2017: Best Practice & Research. Clinical Anaesthesiology
Connie P C Ow, Jennifer P Ngo, Md Mahbub Ullah, Lucinda M Hilliard, Roger G Evans
Tissue hypoxia has been proposed as an important factor in the pathophysiology of both chronic kidney disease and acute kidney injury, initiating and propagating a vicious cycle of tubular injury, vascular rarefaction, and fibrosis and thus exacerbation of hypoxia. Here, we critically evaluate this proposition by systematically reviewing the literature relevant to the following six questions: (1) Is kidney disease always associated with tissue hypoxia? (2) Does tissue hypoxia drive signaling cascades that lead to tissue damage and dysfunction? (3) Does tissue hypoxia per se lead to kidney disease? (4) Does tissue hypoxia precede pathology? (5) Does tissue hypoxia co-localize with pathology? (6) Does prevention of tissue hypoxia prevent kidney disease? We conclude that tissue hypoxia is a common feature of both acute kidney injury and chronic kidney disease...
November 21, 2017: Acta Physiologica
Heather M Perry, Liping Huang, Rebecca J Wilson, Amandeep Bajwa, Hiromi Sesaki, Zhen Yan, Diane L Rosin, David F Kashatus, Mark D Okusa
The proximal tubule epithelium relies on mitochondrial function for energy, rendering the kidney highly susceptible to ischemic AKI. Dynamin-related protein 1 (DRP1), a mediator of mitochondrial fission, regulates mitochondrial function; however, the cell-specific and temporal role of DRP1 in AKI in vivo is unknown. Using genetic murine models, we found that proximal tubule-specific deletion of Drp1 prevented the renal ischemia-reperfusion-induced kidney injury, inflammation, and programmed cell death observed in wild-type mice and promoted epithelial recovery, which associated with activation of the renoprotective β -hydroxybutyrate signaling pathway...
January 2018: Journal of the American Society of Nephrology: JASN
Manisha Singh, Nithin Karakala, Sudhir V Shah
Acute kidney injury (AKI) occurs in approximately 10% to 15% of hospital-admitted patients and is associated with in-hospital mortality of 50% in patients requiring renal replacement therapy. Recently, multiple observational studies have demonstrated that patients who survive AKI have significant long-term consequences including cardiovascular events, progression to advanced-stage chronic kidney disease (CKD), and mortality. A direct link between AKI and CKD is provided by studies that demonstrate that some patients with normal renal function who develop AKI requiring dialysis never recover...
November 2017: Journal of Renal Nutrition
Fengming Zhu, Octavia L S Chong Lee Shin, Guangchang Pei, Zhizhi Hu, Juan Yang, Han Zhu, Meng Wang, Jingyi Mou, Jie Sun, Yuxi Wang, Qian Yang, Zhi Zhao, Huzi Xu, Hui Gao, Weiqi Yao, Xiao Luo, Wenhui Liao, Gang Xu, Rui Zeng, Ying Yao
Acute kidney injury (AKI) predisposes patients to an increased risk into progressive chronic kidney disease (CKD), however effective treatments are still elusive. This study aimed to investigate the therapeutic efficacy of human adipose-derived MSCs (hAD-MSCs) in the prevention of AKI-CKD transition, and illuminate the role of Sox9, a vital transcription factor in the development of kidney, in this process. C57BL/6 mice were subjected to unilateral renal ischemia/reperfusion (I/R) with or without hAD-MSC treatment...
September 19, 2017: Oncotarget
Ixchel Lima-Posada, Cinthya Portas-Cortés, Rosalba Pérez-Villalva, Francesco Fontana, Roxana Rodríguez-Romo, Rodrigo Prieto, Andrea Sánchez-Navarro, Guadalupe L Rodríguez-González, Gerardo Gamba, Elena Zambrano, Norma A Bobadilla
This study evaluated if there is a sexual dimorphism in the acute kidney injury (AKI) to chronic kidney disease (CKD) transition and the time-course of the potential mechanisms involved in the dimorphic response. Female and male rats were divided into sham-operated or underwent 45-min renal ischemia (F + IR, and M + IR). All groups were studied at 24-h and 1, 2, 3, or 4-months post-ischemia. Additionally, oophorectomized rats were divided into sham or IR groups. After 24-h, AKI extent was simllar in females and males, but female rats exhibited less oxidative stress and increased renal GSH content...
September 25, 2017: Scientific Reports
Jing Liu, Sanjeev Kumar, Egor Dolzhenko, Gregory F Alvarado, Jinjin Guo, Can Lu, Yibu Chen, Meng Li, Mark C Dessing, Riana K Parvez, Pietro E Cippà, A Michaela Krautzberger, Gohar Saribekyan, Andrew D Smith, Andrew P McMahon
Though an acute kidney injury (AKI) episode is associated with an increased risk of chronic kidney disease (CKD), the mechanisms determining the transition from acute to irreversible chronic injury are not well understood. To extend our understanding of renal repair, and its limits, we performed a detailed molecular characterization of a murine ischemia/reperfusion injury (IRI) model for 12 months after injury. Together, the data comprising RNA-sequencing (RNA-seq) analysis at multiple time points, histological studies, and molecular and cellular characterization of targeted gene activity provide a comprehensive profile of injury, repair, and long-term maladaptive responses following IRI...
September 21, 2017: JCI Insight
Buyun Wu, Lulu Ma, Yongfeng Shao, Si Liu, Xiangbao Yu, Yamei Zhu, Xianrong Xu, Changying Xing, Huijuan Mao
BACKGROUND/AIMS: To evaluate the long-term outcomes of Chinese patients with cardiac surgery-associated acute kidney injury (CSA-AKI). METHODS: Patients who underwent cardiac surgery with a median 3-year follow-up were enrolled. The long-term survival rate and the incidence of chronic kidney disease (CKD) were recorded, and related risk factors were analyzed. RESULTS: Of all 1,363 patients, 457 (33.5%) developed CSA-AKI. The AKI patients had a lower 3-year survival rate (88...
2017: Blood Purification
Ajay S Rathore, Tushar Chopra, Jennie Z Ma, Wenjun Xin, Emaad M Abdel-Rahman
BACKGROUND/AIMS: Acute kidney injury requiring dialysis (AKI-D) is associated with poor outcomes. Centers for Medicare and Medicaid Services have reversed their clarification allowing AKI-D patients to be dialyzed at outpatient dialysis units. Data assessing long-term outcomes of AKI-D patients and their predictors is needed to adopt guidelines to ensure adequate management. We assessed long-term outcomes and associated risk factors of AKI-D patients who survived 90 days post-hemodialysis (HD) initiation...
2017: Nephron
Samuel A Silver, Edward D Siew
Acute kidney injury (AKI) is an increasingly common condition that is associated with long-term health outcomes. Recent studies have demonstrated that AKI, particularly when severe or persistent, is associated with all-cause mortality, CKD, ESRD, cardiovascular events, and reduced quality of life. However, data from multiple health care systems indicate that most patients do not see a nephrologist, although 1 study has suggested patients with AKI requiring dialysis may benefit from doing so. These observations raise the greater questions of what are the elements of care that may improve outcomes in survivors of AKI and which survivors need to be seen...
July 2017: Advances in Chronic Kidney Disease
2017-08-08 12:58:23
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