Department of Emergency and Critical Care Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan.
Clin Exp Nephrol. 2020 Nov;24(11):979-988. doi: 10.1007/s10157-020-01920-w. Epub 2020 Jun 24.
Acute kidney injury (AKI) is a threatening medical condition associated with poor outcomes at different settings. The development of standardized diagnostic criteria and new biomarkers addressed significant clinical impacts of AKI and the need for an early AKI detection, respectively. There have been some breakthroughs in understanding the pathogenesis of AKI through basic research; however, treatments against AKI aside from renal replacement therapy (RRT) have not shown adequate successful results. Biomarkers that could identify good responders to certain treatment are expected to facilitate translation of basic research findings. Most patients with severe AKI treated with RRT died due to multiple-organ failure, not renal dysfunction. Hence, it is essential to identify other organ dysfunctions induced by AKI as organ crosstalk. Also, a multidisciplinary approach of critical care nephrology is needed to evaluate a complex organ crosstalk in AKI. For disruptive innovation for AKI, we further explore these new aspects of AKI, which previously were considered outside the scope of nephrology.
急性肾损伤（AKI）是一种威胁性的医学病症，在不同环境下与不良预后相关。标准化诊断标准和新型生物标志物的发展分别解决了 AKI 的重大临床影响和早期 AKI 检测的需求。通过基础研究，人们对 AKI 的发病机制有了一些突破性的认识；然而，除了肾脏替代疗法（RRT）之外，针对 AKI 的治疗并没有取得足够的成功结果。能够识别对某些治疗有良好反应的生物标志物有望促进基础研究成果的转化。大多数接受 RRT 治疗的重症 AKI 患者因多器官衰竭而非肾功能衰竭而死亡。因此，识别 AKI 引起的其他器官功能障碍（器官串扰）至关重要。此外，需要采用重症监护肾脏医学的多学科方法来评估 AKI 中的复杂器官串扰。为了推动 AKI 的创新发展，我们进一步探讨了这些 AKI 的新方面，这些方面以前被认为不在肾脏病学的范畴内。
