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Docherty NG, Delles C, López-Hernández FJ. Reframing acute kidney injury as a pathophysiological continuum of disrupted renal excretory function. Acta Physiol (Oxf) 2024:e14181. [PMID: 38808913 DOI: 10.1111/apha.14181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/07/2024] [Accepted: 05/15/2024] [Indexed: 05/30/2024]
Abstract
Surrogate measures of glomerular filtration rate (GFR) continue to serve as pivotal determinants of the incidence, severity, and management of acute kidney injury (AKI), as well as the primary reference point underpinning knowledge of its pathophysiology. However, several clinically important deficits in aspects of renal excretory function during AKI other than GFR decline, including acid-base regulation, electrolyte and water balance, and urinary concentrating capacity, can evade detection when diagnostic criteria are built around purely GFR-based assessments. The use of putative markers of tubular injury to detect "sub-clinical" AKI has been proposed to expand the definition and diagnostic criteria for AKI, but their diagnostic performance is curtailed by ambiguity with respect to their biological meaning and context specificity. Efforts to devise new holistic assessments of overall renal functional compromise in AKI would foster the capacity to better personalize patient care by replacing biomarker threshold-based diagnostic criteria with a shift to assessment of compromise along a pathophysiological continuum. The term AKI refers to a syndrome of sudden renal deterioration, the severity of which is classified by precise diagnostic criteria that have unquestionable utility in patient management as well as blatant limitations. Particularly, the absence of an explicit pathophysiological definition of AKI curtails further scientific development and clinical handling, entrapping the field within its present narrow GFR-based view. A refreshed approach based on a more holistic consideration of renal functional impairment in AKI as the basis for a new diagnostic concept that reaches beyond the boundaries imposed by the current GFR threshold-based classification of AKI, capturing broader aspects of pathogenesis, could enhance AKI prevention strategies and improve AKI patient outcome and prognosis.
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Affiliation(s)
- Neil G Docherty
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin, Ireland
- Disease and Theranostic Modelling (DisMOD) Working Group
| | - Christian Delles
- Disease and Theranostic Modelling (DisMOD) Working Group
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Francisco J López-Hernández
- Disease and Theranostic Modelling (DisMOD) Working Group
- Departamento de Fisiología y Farmacología, Instituto de Investigación Biomédica de Salamanca (IBSAL) de la Fundación Instituto de Ciencias de la Salud de Castilla y León (ICSCYL), Universidad de Salamanca (USAL), Salamanca, Spain
- National Network for Kidney Research RICORS2040 RD21/0005/0004, Instituto de Salud Carlos III, Madrid, Spain
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Vicente-Vicente L, Casanova AG, Tascón J, Prieto M, Morales AI. New Challenges in the Diagnosis of Kidney Damage Due to Immune Checkpoint Inhibitors Therapy: An Observational Clinical Study. Diagnostics (Basel) 2023; 13:2524. [PMID: 37568887 PMCID: PMC10416935 DOI: 10.3390/diagnostics13152524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
In recent years, immunotherapy has been postulated as one of the most effective strategies in the fight against cancer. The greatest success in this field has been achieved with the inhibition of molecules involved in slowing down the adaptive immune response by immune checkpoint inhibitors (ICIs). Despite its efficacy, ICI treatment has side effects. Regarding kidney damage, it is estimated that 4.9% of patients treated with ICIs develop renal injury. Furthermore, cancer patients who develop renal dysfunction have a worse prognosis. Current diagnostics are insufficient to predict the underlying renal injury and to identify the type of damage. Our hypothesis is that the renal injury could be subclinical, so the possibility of using new urinary biomarkers could be a useful diagnostic tool that would allow these patients to be managed in a preventive (risk biomarkers) and early (early biomarkers) way and even to clarify whether the renal damage is due to this therapy or to other factors (differential diagnostic biomarkers). A prospective study to validate risk and early and differential biomarkers in patients treated with ICIs is proposed to test this hypothesis. The results derived from this study will improve the clinical practice of cancer treatment with ICIs and therefore the life expectancy and quality of life of patients. Trial Registration: ClinicalTrials.gov, NCT04902846.
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Affiliation(s)
- Laura Vicente-Vicente
- Toxicology Unit, Universidad de Salamanca, 37007 Salamanca, Spain; (L.V.-V.); (A.G.C.); (J.T.); (M.P.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Universidad de Salamanca, 37007 Salamanca, Spain
- RICORS2040-Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Alfredo G. Casanova
- Toxicology Unit, Universidad de Salamanca, 37007 Salamanca, Spain; (L.V.-V.); (A.G.C.); (J.T.); (M.P.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Universidad de Salamanca, 37007 Salamanca, Spain
- RICORS2040-Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Javier Tascón
- Toxicology Unit, Universidad de Salamanca, 37007 Salamanca, Spain; (L.V.-V.); (A.G.C.); (J.T.); (M.P.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Universidad de Salamanca, 37007 Salamanca, Spain
- RICORS2040-Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Marta Prieto
- Toxicology Unit, Universidad de Salamanca, 37007 Salamanca, Spain; (L.V.-V.); (A.G.C.); (J.T.); (M.P.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Universidad de Salamanca, 37007 Salamanca, Spain
- RICORS2040-Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ana I. Morales
- Toxicology Unit, Universidad de Salamanca, 37007 Salamanca, Spain; (L.V.-V.); (A.G.C.); (J.T.); (M.P.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Universidad de Salamanca, 37007 Salamanca, Spain
- RICORS2040-Instituto de Salud Carlos III, 28029 Madrid, Spain
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Balakhnin DG, Chermnykh II, Ivkin AA, Borisenko DV, Grigoryev EV. The Issue of Acute Kidney Injury in Patients after Cardiac Surgery. MESSENGER OF ANESTHESIOLOGY AND RESUSCITATION 2022. [DOI: 10.21292/2078-5658-2022-19-5-93-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiac surgery associated acute kidney injury (CSA-AKI) is a common complication of cardiac surgery resulting from the patient's exposure to a complex combination of factors in the perioperative period. Current diagnostic criteria for AKI may underestimate the incidence of this complication due to certain specific features of cardiac surgery patients. The introduction of new diagnostic biomarkers of kidney injury into clinical practice has shown the prospective of identifying patients in the early stages of CSA-AKI development. Accurate and timely identification of patients at high risk of developing CSA-AKI can also allow performing comprehensive interventions to prevent it. When diagnosed, CSA-AKI management limited to symptomatic treatment.
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