Evaluation and initial management of acute kidney injury.
The evaluation and initial management of patients with acute kidney injury (AKI) should include: (1) an assessment of the contributing causes of the kidney injury, (2) an assessment of the clinical course including comorbidities, (3) a careful assessment of volume status, and (4) the institution of appropriate therapeutic measures designed to reverse or prevent worsening of functional or structural kidney abnormalities. The initial assessment of patients with AKI classically includes the differentiation between prerenal, renal, and postrenal causes. The differentiation between so-called "prerenal" and "renal" causes is more difficult, especially because renal hypoperfusion may coexist with any stage of AKI. Using a modified Delphi approach, the multidisciplinary international working group, generated a set of testable research questions. Key questions included the following: Is there a difference in prognosis between volume-responsive and volume-unresponsive AKI? Are there biomarkers whose patterns (dynamic changes) predict the severity and recovery of AKI (maximal stage of AKI, need for RRT, renal recovery, mortality) and guide therapy? What is the best biomarker to assess prospectively whether AKI is volume responsive? What is the best biomarker to assess the optimal volume status in AKI patients? In evaluating the current literature and ongoing studies, it was thought that the answers to the questions posed herein would improve the understanding of AKI, and ultimately patient outcomes.
Himmelfarb
Jonathan
J
Division of Nephrology, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, USA. himmej@mmc.org
Joannidis
Michael
M
Molitoris
Bruce
B
Schietz
Miet
M
Okusa
Mark D
MD
Warnock
David
D
Laghi
Franco
F
Goldstein
Stuart L
SL
Prielipp
Richard
R
Parikh
Chirag R
CR
Pannu
Neesh
N
Lobo
Suzana M
SM
Shah
Sudhir
S
D'Intini
Vincent
V
Kellum
John A
JA
D000208:Acute Disease; D015415:Biomarkers / Q000032:analysis; D035843:Biomedical Research / Q000458:organization & administration; D001810:Blood Volume; D015897:Comorbidity; D003245:Consensus Statements as Topic; D003697:Delphi Technique; D018450:Disease Progression; D005440:Fluid Therapy; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D016730:Program Development; D012079:Renal Circulation; D017582:Renal Replacement Therapy; D012307:Risk Factors; D012720:Severity of Illness Index; D009626:Terminology as Topic
D015415:Biomarkers