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Prerenal failure: from old concepts to new paradigms
Etienne Macedo1, Ravindra L Mehta
1Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA.
Current Opinion in Critical Care
|October 27, 2009
Summary
Prerenal failure lacks a clear definition, hindering research on acute kidney injury (AKI). New approaches are needed to classify prerenal states and distinguish them from established AKI using biomarkers.
Area of Science:
- Nephrology
- Renal Medicine
- Acute Kidney Injury Research
Background:
- Prerenal failure, a reversible form of acute renal dysfunction, encompasses diverse conditions.
- Lack of a standardized definition impedes understanding of its epidemiology and outcomes.
Purpose of the Study:
- To review the current understanding of prerenal failure.
- To highlight challenges in defining and classifying prerenal conditions within acute kidney injury (AKI).
- To recommend future research directions.
Main Methods:
- Literature review of diagnostic and staging criteria for AKI.
- Analysis of the concept of prerenal failure in light of new AKI guidelines.
- Appraisal of current status and future research needs.
Main Results:
- New AKI criteria acknowledge mortality risks with minor serum creatinine increases but lack specific prerenal classification.
- The concept of prerenal failure is challenged due to definition ambiguity and difficulty in assessing reversibility.
- Pathophysiology and manifestations of prerenal failure indicate a need for reevaluation.
Conclusions:
- Prerenal failure states require classification based on compensatory capacity, insult characteristics, and comorbidities.
- Biomarkers and identification of high-risk states/processes can help differentiate prerenal conditions from established AKI.
- Further research is recommended to refine diagnostic and classification approaches.
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