title: Prevention and conservative management of acute kidney injury.
abstract: The incidence of acute kidney injury (AKI) is increasing steadily. This can be attributed to a growing prevalence of risk factors for AKI, such as aging, diabetes, underlying cardiovascular disease and the escalating application of more complex procedures. Currently, there is no treatment for established AKI, except for renal replacement therapy in case of life-threatening conditions. The focus should thus be shifted towards AKI prevention rather than treatment. Several promising pharmacological and non-pharmacological interventions for prevention of AKI in animal models did not fulfill the expectations when applied in humans. There are multiple reasons why these interventions prove to be disappointing. The pathophysiology of AKI in different settings has not been fully elucidated, the underlying cause of AKI in the clinical setting is often multifactorial, and animal AKI models often do not mimic human AKI very well. Ischemia-reperfusion models are representative for human AKI in the setting of aortic clamping or in case of delayed graft function after kidney transplantation, but are not suited to study AKI in many other conditions such as sepsis. Moreover, several drugs for AKI prevention are associated with deleterious adverse events in humans as they lack selectivity. In this review, an overview of the strategies that can be used in the clinical setting for AKI prevention will be presented. Potential preventive strategies in certain specific clinical conditions will also be reviewed.
authors.affiliation: Renal Division, Ghent University Hospital, Ghent, Belgium - jill.vanmassenhove@ugent.be.
authors.forename: Jill
authors.initials: J
authors.lastname: Vanmassenhove
authors.forename: Nic
authors.initials: N
authors.lastname: Veys
authors.forename: Wim
authors.initials: W
authors.lastname: Van Biesen
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D000375:Aging; D000975:Antioxidants / Q000627:therapeutic use; D001530:Belgium / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D048909:Diabetes Complications / Q000453:epidemiology; D019317:Evidence-Based Medicine; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D015994:Incidence; D010353:Patient Education as Topic; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D000975:Antioxidants; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents