Progression after AKI: Understanding Maladaptive Repair... : Journal of the American Society of Nephrology (original) (raw)

Up Front Matters

Understanding Maladaptive Repair Processes to Predict and Identify Therapeutic Treatments

Basile, David P.*; Bonventre, Joseph V.†; Mehta, Ravindra‡; Nangaku, Masaomi§; Unwin, Robert‖; Rosner, Mitchell H.¶; Kellum, John A.**; Ronco, Claudio††

*Department of Cellular and Integrative Physiology and Department of Medicine, Division of Nephrology, Indiana University, Indianapolis, Indiana;

†Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;

‡Division of Nephrology and Hypertension, Department of Medicine, University of California, San Diego, California;

§Division of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Tokyo, Japan;

‖Division of Medicine, University College London Centre for Nephrology, University College London, London, United Kingdom;

¶Department of Medicine, Nephrology Division and the Centre for Immunity, Inflammation and Regenerative Medicine, University of Virginia, Charlottesville, Virginia;

**Center for Critical Care Nephrology, The Clinical Research, Investigation, and Systems Modeling of Acute Illness Centre, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and

††Department of Nephrology Dialysis and Transplantation, San Bortolo Hospital and the International Renal Research Institute, Vicenza, Italy

Correspondence: Dr. David P. Basile, Department of Cellular and Integrative Physiology, 635 Barnhill Drive, Indianapolis, IN. Email: [email protected]

Abstract

Recent clinical studies indicate a strong link between AKI and progression of CKD. The increasing prevalence of AKI must compel the nephrology community to consider the long-term ramifications of this syndrome. Considerable gaps in knowledge exist regarding the connection between AKI and CKD. The 13th Acute Dialysis Quality Initiative meeting entitled “Therapeutic Targets of Human Acute Kidney Injury: Harmonizing Human and Experimental Animal Acute Kidney Injury” convened in April of 2014 and assigned a working group to focus on issues related to progression after AKI. This article provides a summary of the key conclusions and recommendations of the group, including an emphasis on terminology related to injury and repair processes for both clinical and preclinical studies, elucidation of pathophysiologic alterations of AKI, identification of potential treatment strategies, identification of patients predisposed to progression, and potential management strategies.