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Subclinical AKI—an emerging syndrome with important consequences

Nature Reviews Nephrology volume 8, pages 735–739 (2012)Cite this article

Abstract

According to guidelines published by Kidney Disease: Improving Global Outcomes, patients at risk of acute kidney injury (AKI) should be managed according to their susceptibilities and exposures. Clinical evaluation of a patient's risk of acute loss of renal function is of undisputed importance. However, such evaluations can be hindered by the complex presentations of critically ill patients and the lack of methods to detect early kidney damage. In this regard, a tool for diagnosis and stratification of patients at risk of AKI would complement clinical assessments and enable improved therapeutic decision-making. Emerging evidence suggests that 15–20% of patients who do not fulfil current serum-creatinine-based consensus criteria for AKI are nevertheless likely to have acute tubular damage, which is associated with adverse outcomes. This evidence supports reassessment of the concept and evolution of the definition of AKI to incorporate biomarkers of tubular damage.

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Figure 1: New entities within the spectrum of AKI syndrome.
Figure 2: The effect of biomarker status on the outcomes of patients at risk of AKI.

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Authors and Affiliations

  1. Department of Nephrology, Hypertension, Diabetes and Endocrinology, Otto-von-Guericke-University, Leipziger Strasse 44, Magdeburg, 39120, Germany

    Michael Haase

  2. Department of Critical Care Medicine, The CRISMA Center, University of Pittsburgh, School of Medicine Room 604 Scaife Hall, 3550 Terrace Street, Pittsburgh, 15261, PA, USA

    John A. Kellum

  3. Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute (IRRIV), San Bortolo Hospital, Viale Rodolfi 37, Vicenza, 36100, Italy

    Claudio Ronco

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All authors contributed to researching the data for the article, discussions of its content, writing the article and review and/or editing of the manuscript before submission.

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Correspondence to Claudio Ronco.

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Competing interests

M. Haase has received grants from Astute Medical and lecture fees from Abbott, Alere, Fresenius and Roche. J. A. Kellum has received grants from Alere, Astute Medical and Gambro and Baxter, and has acted as a consultant for Abbott, Alere, Astute Medical, Fresenius and Gambro and Baxter. C. Ronco has received speaker honoraria from Abbott, Alere, Gambro, General Electric Company and Merck, and has acted as a consultant for Asahi Kasei Medical and CardioBridge.

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Haase, M., Kellum, J. & Ronco, C. Subclinical AKI—an emerging syndrome with important consequences. Nat Rev Nephrol 8, 735–739 (2012). https://doi.org/10.1038/nrneph.2012.197

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