The kidney is a wonderful organ. It is exquisitely responsive to changes in environment and physiology. What is referred to as acute renal failure in response to acute kidney injury is in some measure acute renal success. A decrease in urine output, for example, in a dehydrated patient helps restore or maintain central volume. Our guest editors have provided a series of articles that address cutting-edge issues in what is now being termed acute kidney injury (AKI) in an attempt to better define and tease out varying causes of acute kidney failure and ultimately improve outcomes.
Dr. Endre gets us on the same page by defining and explaining the new terminology and diagnostic criteria that have been better established in recent years by several working groups and, notably, the international Acute Kidney Injury Network. Achieving consensus on nomenclature and staging of AKI on an international level between nephrologists and intensivists is a major achievement. This new stratification is an important step for further investigation of AKI and therapeutic modalities. Dr. Edelstein explores the expanding world of biomarkers of AKI. None are perfect, but all offer the potential of earlier diagnosis of AKI at a time when therapeutic interventions may make a significant difference.
Drs. Yarlagadda, Klein, and Jani evaluate a special condition, delayed graft function in a kidney allograft and the effect of this special case of acute kidney injury on allograft and patient outcomes. Dr. Bouchard and his colleagues ask the following question: of those patients with AKI who require renal replacement therapy, which type is the most appropriate? Should it be intermittent or continuous? What is the appropriate dialysis dose and how long should dialysis be continued? Dr. Stafford-Smith and coworkers describe AKI in another special condition, after cardiac surgery. They evaluate the pathophysiology of AKI after cardiac surgery and the effects of kidney dysfunction on mortality and long-term outcome as well as the risk of chronic kidney disease.
Drs. Goldstein and Deverajan discuss AKI in the pediatric population and the validation of an AKI classification system for children. They also discuss early biomarkers for both AKI and chronic kidney disease and the importance of large cohort studies to study the sensitivity and specificity of these biomarkers. Many investigators have studied links between the kidney and the lung as described by Dr. Faubel in her article, but the pathophysiology is unclear. As noted by Dr. Faubel, the coexistence of AKI and pulmonary failure is associated with a mortality rate of greater than 80%. Research regarding the pathophysiologic mechanisms and possible treatments is of critical importance. Finally, Drs. Goldberg and Dennen look at the long-term outcomes of AKI, which they believe are significant and underappreciated.
Our section editors have contributed 2 papers. Dr. Eknoyan has written another elegant article on the history of AKI, and Dr. Edwards solicited an article from Drs. Archdeacon and Detwiler regarding the role of bone morphogenetic protein 7 in kidney development and kidney injury. In addition, we have a Wildcard article by Dr. Powe's group regarding the relationship between serum phosphate levels and blood pressure in dialysis patients.
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