Revisiting acute kidney injury outcomes in traumatic brain injury

Acute kidney injury in traumatic brain injury is a major concern, affecting up to 10% of the patients in intensive care unit due to multifaceted mechanisms, including hemorrhagic shock, rhabdomyolysis, and brain-kidney cross-talk, compounded by hyperosmolar therapies. A significant challenge is that serum creatinine is considered a late and nonspecific marker, often missing the critical early insult phase. Future strategies for early prediction and prevention must focus on emerging factors, such as preventing hyperchloremia and utilizing novel biomarkers, such as neutrophil gelatinase-associated lipocalin and kidney injury molecule 1, which detect subclinical injury and predict the need for renal replacement therapy. Composite risk stratification tools (e.g., renal angina index) are vital for personalized management. Although over 90% of patients recover renal function, prevention of collateral damage to the kidney must be recognized as a critical priority in traumatic brain injury care.