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Evaluation and Initial Management of Acute Kidney Injury

Jonathan Himmelfarb^*, Michael Joannidis, Bruce Molitoris, Miet Schietz, Mark D. Okusa^||, David Warnock^¶, Franco Laghi^**, Stuart L. Goldstein, Richard Prielipp, Chirag R. Parikh, Neesh Pannu^||||, Suzana M. Lobo^¶¶, Sudhir Shah^***, Vincent D'Intini, and John A. Kellum

^* Maine Medical Center, Portland, Maine; Medical University of Innsbruck, Innsbruck, Austria; Indiana University School of Medicine, Indianapolis, Indiana; University Hospital Gasthuisberg, Leuven, Belgium; ^|| University of Virginia, Charlottesville, Virginia; ^¶ University of Alabama School of Medicine, Birmingham, Alabama; ^** Loyola University of Chicago, Stritch School of Medicine, Maywood, Illinois; Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Mayo Clinic, Minneapolis, Minnesota; Yale University, New Haven, Connecticut; ^|| University of Alberta, Edmonton, Alberta, Canada; ^¶ Sao Jose Rio Preto Medical School, Sao Jose, Brazil; ^*** University of Arkansas, Little Rock, Arkansas; Geelong Hospital, Geelong, Victoria, Australia; and University of Pittsburgh, Pittsburgh, Pennsylvania

Correspondence: Dr Jonathan Himmelfarb, Division of Nephrology, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102. Phone: 207-662-2417; Fax: 207-662-630; E-mail: himmej{at}mmc.org

The evaluation and initial management of patients with acute kidney injury (AKI) should include: (1) an assessment of the contributing causes of the kidney injury, (2) an assessment of the clinical course including comorbidities, (3) a careful assessment of volume status, and (4) the institution of appropriate therapeutic measures designed to reverse or prevent worsening of functional or structural kidney abnormalities. The initial assessment of patients with AKI classically includes the differentiation between prerenal, renal, and postrenal causes. The differentiation between so-called "prerenal" and "renal" causes is more difficult, especially because renal hypoperfusion may coexist with any stage of AKI. Using a modified Delphi approach, the multidisciplinary international working group, generated a set of testable research questions. Key questions included the following: Is there a difference in prognosis between volume-responsive and volume-unresponsive AKI? Are there biomarkers whose patterns (dynamic changes) predict the severity and recovery of AKI (maximal stage of AKI, need for RRT, renal recovery, mortality) and guide therapy? What is the best biomarker to assess prospectively whether AKI is volume responsive? What is the best biomarker to assess the optimal volume status in AKI patients? In evaluating the current literature and ongoing studies, it was thought that the answers to the questions posed herein would improve the understanding of AKI, and ultimately patient outcomes.

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Paul M. Palevsky
Clin. J. Am. Soc. Nephrol. 2008 3: 933-934. [Full Text] [PDF]

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				P. M. Palevsky Setting the Agenda Clin. J. Am. Soc. Nephrol., July 1, 2008; 3(4): 933 - 934. [Full Text] [PDF]