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Renal recovery after severe acute renal injury.
Eur J Med Res. 2008 Dec 03; 13(12):552-6.EJ

Abstract

BACKGROUND

Recovery of renal function after acute renal injury is an important clinical determinant of patient morbidity and mortality. However, studies covering this field are scarce and nonhomogeneous.

FINDINGS

Despite success in animal models, translation of current pharmacologic strategies to limit the extent of kidney dysfunction or to hasten renal recovery from acute kidney injury (AKI) in human studies has failed. Renal replacement therapy is the mainstay of supportive care in patients with AKI. However, its performance can have untoward effects that contribute to the prolongation of the course of AKI or impede the ultimate recovery of complete renal function. Use of biocompatible membranes, daily hemodialysis, advanced intermittent hemodialysis (IHD) technology or continuous RRT (CRRT) have been coupled with shortened renal recovery after AKI. Rate of renal recovery to RRT independence is variable when judged at hospital discharge. The frequency of end-stage renal disease in survivors from AKI is highest in severe acute parenchymal renal disease and lowest in acute tubular necrosis (ATN). Renal recovery is less likely in patients with preexisting renal disease. Renal recovery at hospital discharge may underestimate the true rate of renal recovery. The overwhelming majority of patients (more than 85 %) with severe ATN precipitating on normal renal function recover and maintain complete renal function or any degree of chronic renal functional impairment within 6-12 months after AKI. Partial or nonrecovery of renal function represents an independent predictor of long-term mortality for survivors from AKI. Re-need for RRT occurs in a small portion of survivors of severe ATN (less than 5%).

CONCLUSION

Severe AKI necessitating RRT should no longer simply be viewed as just an acute reversible complication of critical illness or short-term illness. Persistent reduction in renal function will exhibit independent effects on patient survival that extends well beyond discharge from the hospital.

Authors+Show Affiliations

Schiffl H
Department of Internal Medicine, Section of Nephrology, University Hospital-Campus Innenstadt, University of Munich, Munich Germany. hschiffl@hotmail.com

MeSH

Acute Kidney InjuryFollow-Up StudiesGlomerular Filtration RateHumansKidneyKidney DiseasesKidney Function TestsRecovery of FunctionRenal DialysisRenal Replacement TherapySeverity of Illness IndexSurvival AnalysisTime FactorsTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19073394

Citation

Schiffl, H. "Renal Recovery After Severe Acute Renal Injury." European Journal of Medical Research, vol. 13, no. 12, 2008, pp. 552-6.
Schiffl H. Renal recovery after severe acute renal injury. Eur J Med Res. 2008;13(12):552-6.
Schiffl, H. (2008). Renal recovery after severe acute renal injury. European Journal of Medical Research, 13(12), 552-6.
Schiffl H. Renal Recovery After Severe Acute Renal Injury. Eur J Med Res. 2008 Dec 3;13(12):552-6. PubMed PMID: 19073394.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Renal recovery after severe acute renal injury. A1 - Schiffl,H, PY - 2008/12/17/entrez PY - 2008/12/17/pubmed PY - 2009/1/17/medline SP - 552 EP - 6 JF - European journal of medical research JO - Eur J Med Res VL - 13 IS - 12 N2 - BACKGROUND: Recovery of renal function after acute renal injury is an important clinical determinant of patient morbidity and mortality. However, studies covering this field are scarce and nonhomogeneous. FINDINGS: Despite success in animal models, translation of current pharmacologic strategies to limit the extent of kidney dysfunction or to hasten renal recovery from acute kidney injury (AKI) in human studies has failed. Renal replacement therapy is the mainstay of supportive care in patients with AKI. However, its performance can have untoward effects that contribute to the prolongation of the course of AKI or impede the ultimate recovery of complete renal function. Use of biocompatible membranes, daily hemodialysis, advanced intermittent hemodialysis (IHD) technology or continuous RRT (CRRT) have been coupled with shortened renal recovery after AKI. Rate of renal recovery to RRT independence is variable when judged at hospital discharge. The frequency of end-stage renal disease in survivors from AKI is highest in severe acute parenchymal renal disease and lowest in acute tubular necrosis (ATN). Renal recovery is less likely in patients with preexisting renal disease. Renal recovery at hospital discharge may underestimate the true rate of renal recovery. The overwhelming majority of patients (more than 85 %) with severe ATN precipitating on normal renal function recover and maintain complete renal function or any degree of chronic renal functional impairment within 6-12 months after AKI. Partial or nonrecovery of renal function represents an independent predictor of long-term mortality for survivors from AKI. Re-need for RRT occurs in a small portion of survivors of severe ATN (less than 5%). CONCLUSION: Severe AKI necessitating RRT should no longer simply be viewed as just an acute reversible complication of critical illness or short-term illness. Persistent reduction in renal function will exhibit independent effects on patient survival that extends well beyond discharge from the hospital. SN - 0949-2321 UR - https://www.unboundmedicine.com/medline/citation/19073394/Renal_recovery_after_severe_acute_renal_injury_ L2 - https://medlineplus.gov/kidneydiseases.html DB - PRIME DP - Unbound Medicine ER -