The need for disruptive innovation in acute kidney injury
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INVITED REVIEW ARTICLE
The need for disruptive innovation in acute kidney injury Kent Doi1 Received: 8 January 2020 / Accepted: 13 June 2020 © The Author(s) 2020
Abstract 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. Keywords Biomarker · Animal model · Critical care nephrology · Organ crosstalk
Introduction Acute kidney injury (AKI) is characterized by an acute decline in renal function. Since the concept of AKI was suggested by addressing the importance of early detection and early intervention around 2004–2005 [1, 2], many clinical studies have provided evidences that AKI is significantly associated with poor outcomes in various clinical situations [3]. This has increased awareness on AKI in the area of nephrology and other areas such as critical care medicine and cardiology. Basic research detected pathophysiological pathways that contributed to the development of AKI and subsequent progression of kidney injury using sophisticated techniques such as genetic engineering [4], intravital microscopy [5], and comprehensive analysis of transcriptomics [6] and metabolomics [7]. In AKI diagnosis, several This article was presented as the Oshima Award memorial lecture at the 56th annual meeting of the Japanese Society of Nephrology, held at Tokyo, Japan in 2013. * Kent Doi kdoi‑[email protected] 1
Department of Emergency and Critical Care Medicine, The University of Tokyo, 7‑3‑1 Hongo, Bunkyo, Tokyo 113‑8655, Japan
new biomarkers have been clinically introduced and earlier detection of AKI has become possible in the last decades. However, no significant translation from the bench to the bedside has been attained in therapeutics against AKI. Thus, desired results of AKI research that would provide significant improvements on the outcomes of AKI patients are yet to be achieved.
Diagnosis Serum creatinine and urine output The Kidney Disease Improving Global Outcomes (KDIGO) criteria were published in 2012 and is currently the international gold standard of AKI diagnosis [8]. T
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