Recent update on acute kidney injury and critical dialysis

Abstract

The definition of acute renal failure has not been unified during past five decades. Most clinicians used to define acute renal failure simply by the increase of serum creatinine arbitrarily. Without consistent criteria of acute renal failure, it has become a major barrier to integrate the clinical studies and daily clinical practice. In 2002, to resolve this issue, Acute Dialysis Quality Initiative Group (ADOQI) suggested new diagnostic criteria, RIFLE criteria, for acute renal failure, which was nominated as acute kidney injury (AKI) later. This standardized diagnostic criterion not only provides a platform helping integrate clinical information about AKI but also promote the understanding of its epidemiology. In addition, with the advances of molecular medicine, different perspectives of pathophysiology in AKI can be reached deeply and are also cornerstones of many current developing therapeutic strategies and diagnostic biomarkers including NGAL, IL-18, KIM-1, and Cystatin-C. Early diagnosis of AKI would help primary clinicians prevent its further deterioration and related complications, and augment the chance of renal recovery. Conventional therapies for AKI including volume expansion, renal perfusion maintenance, nephrotoxicity avoidance, and renal replacement therapy (RRT) are still lack of consensus in detail. However, through large clinical trials and meticulous data analysis, both has greatly enhanced the strength of clinical evidence from which more practical recommendations could be extracted.