Acute Kidney Injury

	11.17.2009, Video One SPEAKER: Mario F. Rubin, MD, Physician, MGH; Director, Transplant Nephrology Fellowship, MGH; Coordinator, Renal Unit Outpatient Medical Residency Training Program, MGH; HMS MODERATOR: Joseph V. Bonventre, MD, PhD, Samuel A. Levine Professor of Medicine, HMS; Chief, Renal Division, Department of Medicine, BWH; Director, BWH/HST Division of Biomedical Engineering

Forum Summary

Acute Kidney Injury (AKI) is characterized by a deterioration of renal function over a period of hours to days, resulting in failure of the kidneys to excrete nitrogenous wastes and to maintain electrolyte and acid-base balances.  Predominantly affecting the elderly, AKI has increased in prevalence over the last twenty-five years and is now more common than chronic renal failure.  AKI is usually diagnosed based on the fact that it causes a patient’s level of serum creatinine to rise and causes his or her urine production to fall.  Many drugs, including non-steroidal anti-inflammatory drugs and some antiviral agents, can cause AKI, and AKI can occur in patients who already have chronic kidney disease.  Although the prognosis for a patient with AKI depends on a number of factors, only twenty-five percent of patients regain full kidney function. 

Outcomes for patients with AKI could potentially be improved if new biomarkers of kidney dysfunction were discovered.  The traditional concept of AKI involves an injury phase, a maintenance phase, and a recovery phase.  During the injury phase, the glomerular filtration rate of the kidney, a marker of how well the kidney is functioning, decreases dramatically.  This decrease eventually results in an increase in serum creatinine, but there is a significant lag period between the time at which kidney injury occurs and the time at which changes in serum creatinine can be detected.  Treating AKI as quickly as possible is of great importance, so a biomarker that reflects kidney function with less of a lag period than serum creatinine is highly desirable.   Finding such a biomarker is complicated by the fact that AKI can have multiple etiologies.

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