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Clinical Practice: Editorial

Free Access

Changing Paradigms in Acute Kidney Injury: From Mechanisms to Management

Mehta R.L.a · Andringa K.K.b · Sanders P.W.b, c · Agarwal A.b, c

Author affiliations

aDepartment of Medicine, Division of Nephrology, University of California, San Diego, CA, bDepartment of Medicine, Division of Nephrology, University of Alabama, and cDivision of Nephrology, Birmingham Veterans Administration Medical Center, Birmingham, AL, USA

Corresponding Author

Dr. Anupam Agarwal

Division of Nephrology, University of Alabama at Birmingham

THT 647, 1900 University Blvd

Birmingham, AL 35294 (USA)

E-Mail agarwal@uab.edu

Related Articles for ""

Nephron 2017;137:251–252

Acute kidney injury (AKI) is a rapidly evolving area, where several advances have been made in understanding the mechanisms and pathways of AKI and its effect on other organs. Recent identification of biomarkers has provided new tools and techniques to characterize this disorder. This workshop was a comprehensive review of the most recent developments in the field, and described emerging knowledge from basic and translational research. Results from clinical trials were discussed to define the best strategies for effective management of patients and define the criteria for future studies. This issue summarizes the proceedings from the 7th University of Alabama at Birmingham (UAB)-University of California San Diego (UCSD) O'Brien Core Center for AKI Research symposium held during the 22nd Annual Continuous Renal Replacement Therapy meeting in San Diego, California on Tuesday, March 7, 2017.

The meeting included 26 experts invited from around the world, and over 100 participants were in attendance. Symposia sessions focused on defining key pathways and targets involved in the development and resolution from AKI. Underlying mechanisms contributing to energy metabolism in the basal state and its response to hypoxia and renal stress and link to renal hemodynamics were discussed. A major theme was to explore the contributors to the progression of AKI to CKD, and speakers provided elegant overviews of the experimental evidence and molecular mechanisms that are in play. The pathophysiology of sickle cell nephropathy was elucidated and the role of epigenetic changes, pericyte biology and immune cells were described in relation to transitions from AKI to CKD. New targets for intervention were described including function-blocking integrins, vasopressin, endothelial derived micro particles and non-pharmacological biomechanical approaches to mitigate the effects of AKI.

Translation of pre-clinical studies to human application continues to be an area of intense research. Modifications in pre-clinical study design, use of human kidney organoids as unique opportunities to understand the different manifestations of AKI were discussed. Knowledge obtained from pre-clinical models is now being applied in evaluating the remote effects of AKI and understanding the pathophysiology of sepsis-associated AKI and immune dysfunction in AKI. This knowledge should facilitate the development of strategies for the prevention and management of AKI.

While well-conducted clinical trials are the benchmark for demonstrating efficacy and effectiveness of diagnostic and therapeutic interventions, the importance of adjudication of renal events, pertinent trial endpoints and economic analysis was highlighted. Prevention of peri-operative AKI and protocolized management and follow-up for AKI patients was proposed to improve outcomes.

The UAB-UCSD O'Brien Center provides key resources for investigators pursuing AKI-related research as well as educational outreach through workshops and seminars. The proceedings from this conference [1,2,3,4,5,6,7,8,9,10,11,12,13] provide a collection of papers we hope will stimulate further thought and discussions in the field.

Acknowledgments

We gratefully acknowledge support from the NIH/NIDDK funded UAB-UCSD O'Brien Center for AKI Research (P30 DK079337) for this symposium.

Disclosure Statement

The authors have no conflicts of interest to declare.


References

  1. Poyan Mehr A, Parikh SM: PPARγ-coactivator-1α, nicotinamide adenine dinucleotide and renal stress resistance. Nephron 2017;137:253-255.
  2. Nangaku M, Hirakawa Y, Mimura I, Inagi R, Tanaka T: Epigenetic changes in the acute kidney injury-to-chronic kidney disease transition. Nephron 2017;137:256-259.
  3. Bullen A, Liu ZZ, Hepokoski M, Li Y, Singh P: Renal oxygenation and hemodynamics in kidney injury. Nephron 2017;137:260-263.
  4. Ó hAinmhire E, Humphreys BD: Fibrotic changes mediating acute kidney injury to chronic kidney disease transition. Nephron 2017;137:264-267.
  5. Hukriede N, Vogt A, de Caestecker M: Drug discovery to halt the progression of acute kidney injury to chronic kidney disease: a case for phenotypic drug discovery in acute kidney injury. Nephron 2017;137:268-272.
  6. Dépret F, Prud'homme M, Legrand M: A role of remote organs effect in acute kidney injury outcome? Nephron 2017;137:273-276.
  7. Tanaka S, Inoue T, Hossack JA, Okusa MD: Nonpharmacological, biomechanical approaches to control inflammation in acute kidney injury. Nephron 2017;137:277-281.
  8. Lee SA, Noel S, Sadasivam M, Hamad ARA, Rabb H: Role of immune cells in acute kidney injury and repair. Nephron 2017;137:282-286.
  9. Weller S, Varrier M, Marli Ostermann M: Lymphocyte function in human acute kidney injury. Nephron 2017;137:287-293.
  10. Kwong YD, Liu KD: AKI adjudication: do we need it? Nephron 2017;137:294-296.
  11. Silver SA, Chertow GM: The economic consequences of acute kidney injury. Nephron 2017;137:297-301.
  12. McIlroy DR, Shaw AD, Myles PS: Standardized renal endpoints for perioperative clinical trials: The standardized endpoints in perioperative medicine initiative. Nephron 2017;137:302-305.
  13. Wald R, Kitchlu A, Harel Z, Silver SA: Care of the AKI survivor. Nephron 2017;137:306-309.

Author Contacts

Dr. Anupam Agarwal

Division of Nephrology, University of Alabama at Birmingham

THT 647, 1900 University Blvd

Birmingham, AL 35294 (USA)

E-Mail agarwal@uab.edu


Article / Publication Details

Received: May 26, 2017
Accepted: May 31, 2017
Published online: November 04, 2017
Issue release date: Published online first

Number of Print Pages: 2
Number of Figures: 0
Number of Tables: 0

ISSN: 1660-8151 (Print)
eISSN: 2235-3186 (Online)

For additional information: https://www.karger.com/NEF


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References

  1. Poyan Mehr A, Parikh SM: PPARγ-coactivator-1α, nicotinamide adenine dinucleotide and renal stress resistance. Nephron 2017;137:253-255.
  2. Nangaku M, Hirakawa Y, Mimura I, Inagi R, Tanaka T: Epigenetic changes in the acute kidney injury-to-chronic kidney disease transition. Nephron 2017;137:256-259.
  3. Bullen A, Liu ZZ, Hepokoski M, Li Y, Singh P: Renal oxygenation and hemodynamics in kidney injury. Nephron 2017;137:260-263.
  4. Ó hAinmhire E, Humphreys BD: Fibrotic changes mediating acute kidney injury to chronic kidney disease transition. Nephron 2017;137:264-267.
  5. Hukriede N, Vogt A, de Caestecker M: Drug discovery to halt the progression of acute kidney injury to chronic kidney disease: a case for phenotypic drug discovery in acute kidney injury. Nephron 2017;137:268-272.
  6. Dépret F, Prud'homme M, Legrand M: A role of remote organs effect in acute kidney injury outcome? Nephron 2017;137:273-276.
  7. Tanaka S, Inoue T, Hossack JA, Okusa MD: Nonpharmacological, biomechanical approaches to control inflammation in acute kidney injury. Nephron 2017;137:277-281.
  8. Lee SA, Noel S, Sadasivam M, Hamad ARA, Rabb H: Role of immune cells in acute kidney injury and repair. Nephron 2017;137:282-286.
  9. Weller S, Varrier M, Marli Ostermann M: Lymphocyte function in human acute kidney injury. Nephron 2017;137:287-293.
  10. Kwong YD, Liu KD: AKI adjudication: do we need it? Nephron 2017;137:294-296.
  11. Silver SA, Chertow GM: The economic consequences of acute kidney injury. Nephron 2017;137:297-301.
  12. McIlroy DR, Shaw AD, Myles PS: Standardized renal endpoints for perioperative clinical trials: The standardized endpoints in perioperative medicine initiative. Nephron 2017;137:302-305.
  13. Wald R, Kitchlu A, Harel Z, Silver SA: Care of the AKI survivor. Nephron 2017;137:306-309.
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