Raising Awareness of Acute Kidney Injury: Unfolding the Truth

Abstract

AKI is rarely being recognized as it may take place without any apparent symptoms. Severe AKI is commonly found in intensive care unit (ICU) patients. AKI in the ICU is an independent risk factor for death, as it may cause systemic effects on other vital organs including the lung, heart, liver, brain and immune system. Some studies have reported that AKI increases susceptibility to infection, doubles the rate of respiratory failure and impairs cardiac function. Considering the substantial impacts of AKI in ICU patients, early implementation of preventive measures should be an essential program which consists of developing AKI risk stratification in the ICU and encouraging the use of novel AKI biomarkers (TIMP-2, IGFBP-7, Cystatin C, IL-18,  KIM-1 and NGAL) as well as other risk stratification tools (clinical risk prediction scores, computer algorithms, furosemide stress test). Furthermore, after ICU patients have recovered, AKI survivors are more likely to develop chronic kidney disease (CKD) and end-stage kidney disease (ESKD), imposing significant morbidity in the future. Recent study has shown that nephrologist intervention was associated with lower risk of starting KRT and progression of AKI.

     The coronavirus disease 2019 (COVID-19) pandemic has caused more than 800,000 deaths worldwide. Kidney involvement in patients with COVID-19 may present as proteinuria or hematuria and may lead to acute kidney injury (AKI). Some initial reports showed that the incidence of AKI in COVID cases was negligible. However, later reports suggested that AKI is actually prevalent in patients with COVID-19, particularly in ICU patients. AKI is now considered as a common complication of COVID-19 and it is also associated with adverse outcomes, including development or worsening of comorbidities, yet little is known about the pathogenesis or optimal management of COVID-19-associated AKI.