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Nephrotoxin Microinjection in Zebrafish to Model Acute Kidney Injury
Published on: July 17, 2016
Acute kidney injury: changing lexicography, definitions, and epidemiology
1Maine Medical Center, Portland, ME and Vanderbilt University Medical Center, Nashville, Tennessee, USA. himmej@mmc.org
Abstract:
In recent years, there have been numerous advances in understanding the molecular determinants of functional kidney injury after ischemic and/or toxic exposure. However, translation of successful novel therapies designed to attenuate kidney functional injury from animal models to the clinical sphere has had modest results. This lack of translatability is at least in part due to lack of sufficient standardization in definitions and classification of cases of acute kidney injury (AKI), an incomplete understanding of the natural history of human AKI, and a limited understanding of how kidney injury interacts with other organ system failure in the context of systemic metabolic abnormalities. A concerted effort is now being made by nephrologists and intensivists to arrive at standardized terminology and classification of AKI. There have also been dramatic advances in our understanding of the epidemiology and natural history of AKI, particularly in the hospital and intensive care unit setting. Promising strategies are now being developed which may ultimately lead to improved outcomes for patients at risk for or who have developed AKI, which should be readily testable in the coming decade.
Insights
Advances in understanding acute kidney injury (AKI) are promising, but clinical translation faces challenges due to inconsistent definitions and limited understanding of human AKI progression and interactions with other organ systems. Efforts are underway to standardize AKI classification and improve patient outcomes.
Area of Science:
- Nephrology
- Critical Care Medicine
- Molecular Medicine
Background:
- Significant progress in understanding molecular mechanisms of kidney injury from ischemia/toxins.
- Limited success in translating novel therapies from animal models to human clinical trials.
- Challenges include lack of standardized AKI definitions, incomplete understanding of human AKI natural history, and interactions with systemic conditions.
Purpose of the Study:
- To address the translational gap in acute kidney injury (AKI) therapies.
- To highlight the need for standardized AKI terminology and classification.
- To emphasize advances in understanding AKI epidemiology and natural history.
Main Methods:
- Review of recent advances in molecular determinants of kidney injury.
- Analysis of challenges in clinical translation of AKI therapies.
- Discussion of ongoing efforts by nephrologists and intensivists for standardization.
Main Results:
- Modest results in translating novel therapies for kidney functional injury.
- Identification of key barriers: lack of standardized AKI definitions and classification, incomplete understanding of human AKI natural history, and complex interactions with other organ failures.
- Significant advances in understanding AKI epidemiology and natural history, especially in hospital/ICU settings.
Conclusions:
- Standardized terminology and classification of AKI are being developed.
- Improved understanding of AKI epidemiology and natural history is emerging.
- New strategies are being developed for improved patient outcomes in AKI, with potential for testing in the next decade.
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01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:29Acute Kidney Injury II: Pathophysiology
01:29Acute Kidney Injury III: Clinical Manifestations
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01:22Acute Kidney Injury VI: Nursing Management