Medical therapy of acute kidney injury

Area of Science:

• Nephrology
• Pharmacology
• Critical Care Medicine

Background:

• Acute kidney injury (AKI) poses a significant clinical challenge.
• Current therapeutic approaches primarily involve optimizing renal perfusion and mitigating intrarenal injury mechanisms.

Purpose of the Study:

• To review pharmacologic interventions for AKI prevention and therapy.
• To evaluate strategies targeting renal perfusion and intrarenal pathophysiological processes.

Main Methods:

• Systematic review of prospective randomized controlled trials and human studies.
• Analysis of interventions aimed at optimizing systemic hemodynamics (volume expansion, inotropes, vasopressors).
• Evaluation of agents targeting intrarenal mechanisms: free oxygen radicals, inflammation, tubular cast formation, and regeneration.

Main Results:

• Optimizing systemic hemodynamics is a key strategy for improving renal perfusion.
• Selective renal vasodilatation trials have largely been unsuccessful, with limited exceptions like theophylline for specific AKI types.
• Studies on intrarenal interventions (N-acetylcysteine, mannitol, antioxidants) show heterogeneous results, lacking convincing evidence of significant benefit.

Conclusions:

• Pharmacologic interventions for AKI require further investigation.
• Current evidence does not convincingly support the widespread use of specific agents for AKI prevention or treatment beyond supportive hemodynamic management.