Acute Kidney Injury and Chronic Kidney Disease as Interconnected Syndromes

By L. Chawla, Paul Eggers, R. Star, P. Kimmel. New England Journal of Medicine, 2014

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For more than 40 years, nephrologists have classified diminished kidney function as two distinct syndromes — acute and chronic kidney failure. Whereas chronic kidney disease was recognized in the 19th century, acute renal dysfunction became evident during the London Blitz of World War II, with the realization that crush injuries could cause dramatic but often reversible cessation of renal function. The disease states and stages of both acute and chronic renal syndromes are delineated according to the serum creatinine concentration or the glomerular filtration rate (GFR), functional markers that were identified in the early 20th century. 1 Advanced renal impairment in both syndromes is treated with dialysis. During the past decade, separate conceptual models for chronic kidney disease 2 and acute kidney injury 3 were developed to facilitate organized approaches to clinical research and trials. However, recent epidemiologic and mechanistic studies suggest that the two syndromes are not distinct entities but rather are closely interconnected — chronic kidney disease is a risk factor for acute kidney injury, acute kidney injury is a risk factor for the development of chronic kidney disease, and both acute kidney injury and chronic kidney disease are risk factors for cardiovascular disease (Fig. 1). 4

Subfields: Nephrology, Surgery

View Paper: https://www.semanticscholar.org/paper/6accc3c8917fce5c908fe4b9191c8350b995deaf

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Citations in the corpus

AKI in Hospitalized Patients with COVID-19. (2020, neutral): “ALT (U/L) 30 (18-49) 25 (15-45) 27 (18-48) 33 (21-61) <0.”
Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup (2017, neutral): “Stage 2 AKI might rapidly reverse (4).”
EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. (2018, background): “Alfapump® had no effect on survival and was associated with a significantly higher incidence of serious adverse events (85.2 vs. 45.2%), mainly represented by AKI [126].”
Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study (2015, background): “These outcomes suggest the important economic and social impact of AKI in this patient population [1, 2, 6].”