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Why are patients still getting and dying from acute kidney injury?

Kellum, John A.

Current Opinion in Critical Care: December 2016 - Volume 22 - Issue 6 - p 513–519
doi: 10.1097/MCC.0000000000000358
RENAL SYSTEM: Edited by John Kellum

Purpose of review Acute kidney injury is common and is associated with increased morbidity and mortality. Rates of acute kidney injury in most settings remain high and in some settings are increasing. Moreover, outcomes associated with acute kidney injury remain relatively poor. This review focuses on recent advances in understanding of acute kidney injury and discusses possible interventions based on these advances.

Recent findings Acute kidney injury is not a disease with a single etiology and clinical course but rather a loose collection of syndromes whose unifying phenotype is an acute loss of glomerular filtration. Traditional taxonomy based on anatomic locations (pre, intra, and post) in reference to the kidney is overly simplistic and has given way to specific ‘endotypes’ including hepatorenal, cardiorenal, nephrotoxic, and sepsis-associated and these syndromes all have unique pathophysiologies and treatments. Our tendency to lump all of these clinical syndromes into a single disease and seek a single treatment has led to the profound lack of progress observed in terms of improving outcomes. The hope is that this is about to change.

Summary Understanding the epidemiology, pathogenesis, and pathophysiology of acute kidney injury is critical to achieving improved outcomes for the millions of patients who develop this loose constellation of syndromes.

Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pennsylvania, USA

Correspondence to Dr John A. Kellum, MD, MCCM, Professor of Critical Care Medicine, Medicine, Clinical and Translational Science, and Bioengineering, Director, Center for Critical Care Nephrology, 604, Scaife Hall, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261, USA. Tel: +1 412 647 8110; fax: +1 412 647 2645; e-mail:

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