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Los Angeles Times
2 days ago
- General
- Los Angeles Times
Acute Kidney Injury: From Early Signs to Chronic Risk
Acute kidney injury (AKI) isn't just a short-term problem—it's the start of a longer kidney health journey. AKI was previously called 'acute renal failure' or 'renal failure' but the terminology has evolved to reflect the spectrum of kidney injury. AKI occurs when the kidneys suddenly stop filtering waste products from the blood and the kidney function changes rapidly. This complication is very different from diseases such as Polycystic Kidney Disease, which is a genetic disease and genetic disorder caused by gene mutations passed from biological parents to their children. Whether it happens in the ICU or outpatient clinic AKI carries a big burden: increased risk of hospitalization, long term dialysis and even premature death. AKI is common in hospitalized patients and patients admitted to hospital and impacts outcomes and length of stay. Recognizing it early, treating it promptly and understanding the link to chronic kidney disease (CKD) is key to preserving kidney function and better patient outcomes. AKI and CKD are both forms of renal disease and show the continuum between acute and chronic conditions. Let's look at how AKI is classified, how to detect it early and what modern tools and strategies are helping clinicians change the trajectory from injury to recovery. AKI is classified by where the problem starts: The KDIGO clinical practice guideline (Kidney Disease: Improving Global Outcomes) defines AKI using changes in serum creatinine levels and urine output. The urine output criteria are also used in AKI staging, such as less than 0.5 mL/kg/h for specified durations. The Acute Kidney Injury Network (AKIN) is another classification system that incorporates both serum creatinine and urine output criteria. Early detection and classification are key, with identification of renal dysfunction and monitoring of glomerular filtration rate (GFR) as key measures of kidney health. But while these have been the clinical mainstays, they aren't always fast or specific enough to catch injury early. Serum creatinine level and blood urea nitrogen are traditional markers for assessing renal function but both have limitations in sensitivity and specificity. That's where newer biomarkers like neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1) and cystatin C come in. These tools are changing early detection, helping clinicians distinguish between mild, reversible cases and more severe or ongoing damage [2] [3]. A 2021 article highlights the importance of fluid balance, electrolyte monitoring and timely renal replacement therapy (RRT) when AKI is confirmed [3]. In the outpatient space, some reviews suggest early medication adjustment and specialist referrals can reduce complications in patients managed outside the hospital [4]. In the context of pathophysiology blood clots can cause vascular obstruction leading to AKI and red blood cells may be seen in kidney biopsies in certain conditions such as anticoagulant-related nephropathy. [5] Prevention starts by identifying who's most at risk. People with diabetes, hypertension, chronic heart failure, or advanced age are more likely to develop AKI—especially during acute illnesses or when exposed to nephrotoxic medications like NSAIDs or contrast agents. Both patient-related and treatment-related risk factors such as underlying chronic diseases, recent infections, trauma or major surgeries play a key role in increasing the likelihood of AKI. According to a 2020 Journal of Clinical Medicine review, risk mitigation means taking a proactive, team-based approach: monitor hydration, avoid nephrotoxins and assess kidney function during high-risk scenarios like surgery or infection [7]. It's especially important to identify high risk patients, such as those undergoing major procedures like cardiac surgery and tailor perioperative management strategies to prevent renal complications. Hospital-based strategies such as standardized monitoring protocols and early nephrology involvement can also reduce AKI rates as emphasized by the American Journal of Kidney Diseases Core Curriculum [11]. In a more recent 2025 article in Lakartidningen Swedish clinicians advocate for a streamlined system to identify and intervene early in AKI cases, especially in older adults or those with fluctuating blood pressure [10]. Relying solely on serum creatinine to assess kidney health is a bit like using a smoke detector after the fire's already burning. Biomarkers offer a more sensitive way to detect kidney injury before significant function is lost. Blood tests are essential for detecting changes in kidney function and guiding the management of AKI patients. A 2022 review in Medicina presents compelling evidence that biomarkers can guide both diagnosis and risk stratification, helping clinicians decide when to intensify care or when to hold off on aggressive treatments [6]. These biomarkers also help distinguish between transient AKI (due to things like dehydration) and persistent AKI, which is more likely to result in long-term damage. This distinction is critical when managing critically ill patients or adjusting medications like ACE inhibitors and diuretics. One of the biggest changes in kidney medicine over the past decade is that AKI doesn't always resolve cleanly. Many patients recover creatinine levels but their kidneys never return to full health. This transitional phase, called acute kidney disease (AKD), spans from 7 to 90 days after AKI onset. Renal recovery after AKI depends on factors such as the severity of injury, underlying comorbidities and the presence of biomarkers indicating renal repair mechanisms. A 2022 Nephron review calls AKD the 'missing link' between AKI and CKD, emphasizing the need for follow-up labs and patient education [8]. If kidney function hasn't bounced back within that 90-day window CKD is usually diagnosed. New research in the Yonsei Medical Journal shows how early post-discharge care—such as nephrology visits, medication reviews and blood pressure control—can slow progression to irreversible kidney damage [9]. Kidney disease progression after AKI increases the risk of developing chronic renal failure, chronic kidney failure, end stage kidney disease and end stage renal disease. Meanwhile a 2024 American Journal of Physiology review looks into the biological mechanisms behind this progression. It points to inflammation, fibrosis (scarring) and microvascular injury as key drivers—and possible therapeutic targets—of the AKI-to-CKD transition [12]. Cardiovascular disease is also a major cause of morbidity and mortality in patients with a history of AKI. When it comes to managing AKI a few core principles apply across both hospital and outpatient settings: The Acute Dialysis Quality Initiative (ADQI) has developed consensus guidelines and classification systems for AKI management. The sooner these are implemented the better the chances of preventing permanent kidney damage and the slide to CKD. Acute kidney injury is more than a short term health crisis—it's a long term disease. As we learn more about AKI we have more opportunity to intervene early, personalize care and protect long term kidney health. By using advanced biomarkers, prevention focused strategies and recognizing AKD as a key phase clinicians can change the story for thousands of patients with kidney injury every year. [1] Rahman, M., Shad, F., & Smith, M. C. (2012). Acute kidney injury: a guide to diagnosis and management. American family physician, 86(7), 631–639. [2] Mercado, M. G., Smith, D. K., & Guard, E. L. (2019). Acute Kidney Injury: Diagnosis and Management. American family physician, 100(11), 687–694. [3] Kellum, J. A., Romagnani, P., Ashuntantang, G., Ronco, C., Zarbock, A., & Anders, H. J. (2021). Acute kidney injury. Nature reviews. Disease primers, 7(1), 52. [4] Jacob, J., Dannenhoffer, J., & Rutter, A. (2020). Acute Kidney Injury. Primary care, 47(4), 571–584. [5] Neyra, J. A., & Chawla, L. S. (2021). Acute Kidney Disease to Chronic Kidney Disease. Critical care clinics, 37(2), 453–474. [6] Yoon, S. Y., Kim, J. S., Jeong, K. H., & Kim, S. K. (2022). Acute Kidney Injury: Biomarker-Guided Diagnosis and Management. Medicina (Kaunas, Lithuania), 58(3), 340. [7] Gameiro, J., Fonseca, J. A., Outerelo, C., & Lopes, J. A. (2020). Acute Kidney Injury: From Diagnosis to Prevention and Treatment Strategies. Journal of clinical medicine, 9(6), 1704. [8] Levey A. S. (2022). Defining AKD: The Spectrum of AKI, AKD, and CKD. Nephron, 146(3), 302–305. [9] Koh, E. S., & Chung, S. (2024). Recent Update on Acute Kidney Injury-to-Chronic Kidney Disease Transition. Yonsei medical journal, 65(5), 247–256. [10] Bell, M., M Öberg, C., & Ewert Broman, M. (2025). Akut njurskada – prevention och behandling [Acute kidney injury - prevention and treatment]. Lakartidningen, 122, 23182. [11] Moore, P. K., Hsu, R. K., & Liu, K. D. (2018). Management of Acute Kidney Injury: Core Curriculum 2018. American journal of kidney diseases : the official journal of the National Kidney Foundation, 72(1), 136–148. [12] Zhang, T., Widdop, R. E., & Ricardo, S. D. (2024). Transition from acute kidney injury to chronic kidney disease: mechanisms, models, and biomarkers. American journal of physiology. Renal physiology, 327(5), F788–F805.
What's On
25-03-2025
- Entertainment
- What's On
6 affordable Eid gifting ideas in Abu Dhabi
Treat yours without breaking the bank… Eid is almost upon us, and that means family, friends, celebrations, and…gifting. Here are 6 affordable Eid gifting ideas in Abu Dhabi. A treasure chest from… FLOWWOW The best part? You can just send them to your friends or family, and they won't (necessarily) need to hunt for it. Why? Because this isn't just a regular treasure chest, it's loaded with an exquisite collection of premium Arabian treats such as chocolate-covered pistachio maamoul, Arabic baklava, Turkish delight, caramel pecans, almond dragees, mixed nuts, a crystal essence bukhoor burner, a Turkish coffee kanaka and other treats. You can also show off the treasure chest as a display piece long after the treats are gone. The pomegranate is a symbol of abundance, prosperity and good fortune, we're told. Gift your loved ones these neat ceramic pomegranate-shaped bowls, hand-painted with gold dots and trimming – they make for a beautiful addition to your living space, kitchen counter or coffee table. Ideal for when you want to grab your favourite nibbles, or to serve snacks or ice-cream when you have guests over. Dhs145, Wicks and Pages Candle Poured here in the UAE, each of their candles is made of 100 per cent soy wax, and lead-free and zinc-free cotton wicks. They also use carcinogen-free, non-toxic fragrance oils, infused with essential oils. Explore their great line of scents, including Desert Stories , Netflix & Chill , Mince Pie , and Spiced Orange . Cliched? Just give 'em a whiff. from Dhs45, Humantra Apricot Electrolyte Mix Our guess is you and yours are going to be running around a good bit over the holidays, so this is a good option to stay hydrated. The UAE's favourite electrolyte drink mix brand, Humantra has just released a cool new Qamar al-Din inspired Apricot flavour, and you'll want to grab a box (or get your loved ones one) this Eid. With those cherished winter feels booking their departures as abruptly as they made their entrance, a hydrating electrolyte mix is one surefire way to stay charged over the holidays. Get yours now on Deliveroo. Dhs125, @deliveroo_ae A razor-sharp makeover at AKIN Give your loved ones the gift of looking sharp this Eid, at AKIN. Holidays are a time of togetherness, and that means new experiences, adventures, and photo-ops. AKIN's first Abu Dhabi outlet at Al Raha beach, complemented by gorgeous seaside views and a welcome coffee when you arrive makes this the ideal spot for a tune up or fresh look so you look great in your pictures, and feel better. Let their master hairdressers tend to your tresses, give you that 'gramworthy fade, or an incredible hot towel shave that will leave you looking and feeling like a million bucks. They also stock a great line-up of grooming products and a cool t- shirt collection (that's a gift idea in itself). Get a gift voucher here. AKIN, Al Raha Beach, Abu Dhabi, 9am to 8pm daily. @akinbarber Juan Valdez Coffee If we had a Dirham for every time we heard people say 'I'm looking for a practical gift'… And if you're a connoisseur of authentic roasts like we are, you'll definitely want to give this one a try. Juan Valdez has arrived in the capital with a whole lot of legacy and an amazing line of Colombian coffees, and the brand new Abu Dhabi outlet promises a dining experience that complements its signature brews. Let this renowned Colombian coffee brand help you stay wired during the Eid break, so you can stay at peak energy levels throughout your itinerary of holiday ideas, plans and socialising. @ > Sign up for FREE to get exclusive updates that you are interested in
